Impact of chronic kidney disease on the prevalence of cardiovascular disease in patients with type 2 diabetes in Spain: PERCEDIME2 study

Abstract

BackgroundThe presence of chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM) increases the risk of cardiovascular disease (CVD) regardless of the presence of traditional cardiovascular risk factors. There is controversy about the impact of each of the manifestations of CKD on the prevalence of CVD, whether it is greater with decreased estimated glomerular filtration rate (eGFR) or increased urine albumin creatinine ratio (UACR).MethodsThis study is a national cross-sectional study performed in primary care consults. We selected participants of both sexes who were aged 40 years or older, had been diagnosed with T2DM and had complete information on the study variables recorded in their medical records. The participants were classified according to eGFR : ≥ 60; 45–59; 30–44; <30 mL/min/1.73 m2 and UACR : < 30; 30–299; ≥300 mg/gr. The results were adjusted to compare the prevalence of CVD across all categories.ResultsA total of 1141 participants were included. Compared to participants with eGFR > 60 mL/min/1.73 m2 those with eGFR between 30–44 mL/min/m2, (OR = 2.3; 95% CI, 1.4-3.9); and eGFR < 30 mL/min/1.73 m2 (OR = 4.1 95% CI 1.6-10.2) showed increased likelihood of having CVD. Participants with UACR ≥ 30 mg/g compared to participants with UACR < 30 mg/g increased significantly the likelihood of having CVD, especially with UACR above 300 mg/g, (OR = 1.6; 95% CI 1.1-2.4 for UACR = 30–299 mg/g; OR = 3.9; CI 1.6-9.5 for UACR ≥ 300 mg/g).ConclusionThe decrease in eGFR and increase in UACR are independent risk factors that increase the prevalence of CVD in participants with T2DM and these factors are independent of each other and of other known cardiovascular risk factors. In our study the impact of mild decreased eGFR in T2DM on CVD was lower than the impact of increased UACR. It is necessary to determine not only UACR but also eGFR for all patients with T2DM, both at the time of diagnosis and during follow-up, to identify those patients at high risk of cardiovascular complications.

Sex differences in vascular stiffness and relationship to the risk of renal functional decline in patients with type 2 diabetes

“…[23][24][25] Moreover, the development of renal disease itself, which our patients are at risk of developing, further increases the CVD risk. 26,27 In the Kidney Early Evaluation Program (KEEP), in which 14,631 patients were followed up for 8 years, body mass index was not predictive of ESRD in people of Black or White racial origin. 28 However, in the prospective, multi-ethnic cohort WHI study, increased waist circumference was associated with a near threefold increased risk of ESRD and death.…”

Gender differences in the progression of target organ damage in patients with increased insulin resistance: the LOD-DIABETES study

“…Cardiovascular disease (CVD) morbidity and mortality is greater in people with increased insulin resistance [(type 2 diabetes mellitus (T2DM) or metabolic syndrome (MetS)] [ 1 – 3 ]. The presence of vascular [ 4 – 6 ], cardiac [ 7 ] and renal [ 8 , 9 ] target organ damage (TOD) increases the risk of cardiovascular complications independent of the existing estimated risk [ 10 ]. In the general population the overall median age for evident CVD is about 9 years lower in men than in their women counterparts worldwide [ 11 ], except in diabetic women who have a higher risk of CVD than diabetic men [ 12 ].…”

The impact of the quality of care and other factors on progression of chronic kidney disease in Thai patients with Type 2 Diabetes Mellitus: A nationwide cohort study

“…Type 2 diabetes mellitus (T2DM) is the leading cause of CKD worldwide and the prevalence of CKD in T2DM patients is 43.5% in the US [ 4 ], 38% in Belgium [ 5 ], 34.7% in Finland [ 6 ] and 22.9% in the Mediterranean area [ 7 ]. Furthermore, CKD patients have 2 to 4 times the risk of cardiovascular disease [ 8 ], and 3 times the risk of mortality relative to T2DM patients without CKD [ 9 ]. Also, quality of life has been shown to be negatively associated with CKD [ 10 ].…”