Mild renal insufficiency as a cardiovascular risk factor in non-proteinuric type II diabetes.
OBJECTIVE
To evaluate cardiovascular risk according to baseline renal function in a group of non-proteinuric type II diabetic patients.


METHODS
Prospective study with a follow-up of 423 non-proteinuric type II diabetic patients with creatinine <150 micromol/l for an average of 4.7 years (S.D. 1.55). Creatinine clearance (CC) was estimated using the Cockcroft-Gault formula and expressed in millilitre per minute. The hazard ratio (HR) associated with each millilitre per minute decrease in baseline CC on fatal or non-fatal cardiovascular events and total mortality was evaluated using the Cox regression model.


RESULTS
Baseline creatinine was 89 micromol/l (S.D. 15.9) and CC was 69.5 ml/min (S.D. 20). There were 63 cardiovascular events (15 unstable angina, 10 non-fatal myocardial infarctions, 25 non-fatal strokes, two amputations, nine fatal myocardial infarctions and two fatal strokes) and 39 total deaths (11 for cardiovascular causes). The cardiovascular event rate was 31.7/1000 patient-years and the total mortality rate was 19.6/1000 patient-years. The independent predictors of cardiovascular events were: CC (HR=1.035; confidence interval (CI) 95% 1.02-1.05; P<0.0001), total cholesterol/HDL cholesterol ratio (HR=1.25; CI 95% 1.1-1.4; P=0.0008), baseline coronary heart disease (HR=2.05; CI 95% 1.07-3.9; P=0.04) and baseline microalbuminuria (HR=2.3; CI 95% 1.3-3.8; P=0.003). The independent total mortality predictors were: CC (HR=1.04; CI 95% 1.02-1.08; P<0.0001), male (HR=2.1; CI 95% 1.1-4; P=0.027) and baseline microalbuminuria (HR=2.1; CI 95% 1.1-4;P=0.03).


CONCLUSIONS
Mild renal insufficiency increases cardiovascular risk in non-proteinuric patients with type II diabetes.
Gimeno-Orna
José A
JA
mjpnosti@eresmas.com
Lou-Arnal
Luis M
LM
Boned-Juliani
Beatriz
B
Molinero-Herguedas
Edmundo
E
D000368:Aged; D000419:Albuminuria / Q000097:blood / Q000175:diagnosis; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D007677:Kidney Function Tests / Q000379:methods / Q000706:statistics & numerical data; D007866:Leg / Q000098:blood supply / Q000473:pathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011379:Prognosis; D051437:Renal Insufficiency / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012307:Risk Factors; D013030:Spain
D008076:Cholesterol, HDL; D002784:Cholesterol; D003404:Creatinine