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Randomized Controlled Trial
. 2013 Sep 18:14:198.
doi: 10.1186/1471-2369-14-198.

Association of chronic kidney disease (CKD) and failure to monitor renal function with adverse outcomes in people with diabetes: a primary care cohort study

Andrew P McGovern  1 , Benjamin Rusholme, Simon Jones, Jeremy N van Vlymen, Harshana Liyanage, Hugh Gallagher, Charles R V Tomson, Kamlesh Khunti, Kevin Harris, Simon de Lusignan
Affiliations
Randomized Controlled Trial

Association of chronic kidney disease (CKD) and failure to monitor renal function with adverse outcomes in people with diabetes: a primary care cohort study

Andrew P McGovern et al. BMC Nephrol. .

Abstract

Background: Chronic kidney disease (CKD) is a known risk factor for cardiovascular events and all-cause mortality. We investigate the relationship between CKD stage, proteinuria, hypertension and these adverse outcomes in the people with diabetes. We also study the outcomes of people who did not have monitoring of renal function.

Methods: A cohort of people with type 1 and 2 diabetes (N = 35,502) from the Quality Improvement in Chronic Kidney Disease (QICKD) cluster randomised trial was followed up over 2.5 years. A composite of all-cause mortality, cardiovascular events, and end stage renal failure comprised the outcome measure. A multilevel logistic regression model was used to determine correlates with this outcome. Known cardiovascular and renal risk factors were adjusted for.

Results: Proteinuria and reduced estimated glomerular filtration rate (eGFR) were independently associated with adverse outcomes in people with diabetes. People with an eGFR < 60 ml/min, proteinuria, and hypertension have the greatest odds ratio (OR) of adverse outcome; 1.58 (95% CI 1.36-1.83). Renal function was not monitored in 4460 (12.6%) people. Unmonitored renal function was associated with adverse events; OR 1.35 (95% CI 1.13-1.63) in people with hypertension and OR 1.32 (95% CI 1.07-1.64) in those without.

Conclusions: Proteinuria, eGFR < 60 ml/min, and failure to monitor renal function are associated with cardiovascular and renal events and mortality in people with diabetes.

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Figures

Figure 1
Figure 1
Hierarchy of clinical tests used for the diagnosis of proteinuria. Threshold values are adapted from the 2008 NICE guidelines [10] and Lamb et al. [31].
Figure 2
Figure 2
Area proportional Venn diagram demonstrating the interrelationship between hypertension, reduced eGFR, and proteinuria in people with diabetes.
Figure 3
Figure 3
Adverse outcomes during 30 month follow up of 35,502 people with diabetes.
Figure 4
Figure 4
Kaplan-Meier event free survival curves by CKD category in people with normotension and hypertension.
See this image and copyright information in PMC

References

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