Diabetes with early kidney involvement may shorten life expectancy by 16 years

Abstract

This study aimed to identify the excess risks associated with diabetic patients with early kidney involvement (early diabetic kidney disease). The mortality risks of early diabetic kidney disease, defined as diabetes in early stages 1-3 chronic kidney disease (CKD), were assessed from a cohort of 512,700 adults in Taiwan participating in a health surveillance program from 1994-2008. Three related groups were identified and compared: diabetes without CKD, early diabetic kidney disease, and early CKD without diabetes. Deaths were ascertained through the National Death Registry. One-third of diabetics had early kidney disease, and approximately two-thirds of patients were classified with early CKD due to proteinuria. Patients with early diabetic kidney disease had more lifestyle risks such as inactivity or obesity, which characteristically amplified excess mortality by up to five times. The three-fold increase in all-cause mortality (hazard ratio 3.16) and a 16-year loss in life expectancy made early diabetic kidney disease a serious and yet often overlooked disease, with most patients unaware of their kidney involvement. Mortality for early diabetic kidney disease was nearly twice as high as that for early CKD (hazard ratio 2.01) or diabetes without CKD (hazard ratio 1.79). The 16-year life span loss is much worse than individually from early CKD (six years) or diabetes (ten years). Thus, identifying early proteinuria among diabetic patients and realizing the importance of reducing lifestyle risks like inactivity is a clinical challenge, but can save lives.

Effect of Linagliptin vs Placebo on Major Cardiovascular Events in Adults With Type 2 Diabetes and High Cardiovascular and Renal Risk

“…High CV risk was defined as a history of coronary artery disease, stroke or peripheral vascular disease, and microalbuminuria or macroalbuminuria, defined as urinary albumin:creatinine ratio (UACR) higher than 30 mg/g or equivalent; high renal risk was defined as (1) estimated glomerular filtration rate (eGFR) of 45 to 75 mL/min/1.73 m 2 and UACR higher than 200 mg/g or equivalent or (2) eGFR of 15 to 45 mL/min/1.73 m 2 regardless of UACR. Participants with end-stage renal disease, defined as an eGFR less than 15 mL/min/1.73 m 2 or requiring maintenance dialysis, were excluded. Full eligibility criteria are provided in Supplement 1.…”

“…T ype 2 diabetes is a major risk factor for cardiovascular (CV) and kidney disease. 1,2 Because of a number of CV safety concerns associated with some glucoselowering agents, [3][4][5] since 2008 evaluation of the CV safety of new glucose-lowering medications, by conducting large noninferiority studies compared with placebo, has been a requirement of both US and European regulators. 6,7 Three CV outcome trials of dipeptidyl peptidase 4 (DPP-4) inhibitors have previously demonstrated a noninferior risk of a composite CV outcome vs placebo but not incremental CV efficacy.…”

“…8 Previous CV outcome trials evaluating glucose-lowering medications for type 2 diabetes enrolled limited numbers of patients with concomitant chronic kidney disease, a group of patients with very high CV risk. 2 Linagliptin is a selective, once-daily, DPP-4 inhibitor approved for glycemic management of type 2 diabetes. [11][12][13] Preliminary early phase 3 clinical data demonstrated that linagliptin had glucose-lowering efficacy and hypothesized potential CV 12 and kidney benefits.…”

Simultaneous angiotensin receptor blockade and glucagon‐like peptide‐1 receptor activation ameliorate albuminuria in obese insulin‐resistant rats

“…Although many factors are associated with the development of CKD, DM is a primary risk factor and accounts for the majority of cases of end‐stage renal disease in the United States . Furthermore, DM with the early development of kidney disease reduces lifespan by 16 years, whereas DM and early kidney disease on their own reduce lifespan by 10 and 6 years, respectively . Therefore, renal function should be monitored in high‐risk individuals such as those with obesity, insulin resistance and hypertension.…”

Diabetic Nephropathy an Obvious Complication in Long Term Type 1 Diabetes Mellitus: A Case Study

“…Diabetic nephropathy (DN) signifies one of the utmost common microvascular problems of Type 1 diabetes mellitus (T1DM) with an increasing frequency worldwide [1]. Which is well-defined as the presence of trace albuminuria followed by a diminished glomerular filtration rate (GFR) [2].…”