title: Reduced glomerular filtration rate in asymptomatic diabetic patients: predictor of increased risk for cardiac events independent of albuminuria.
abstract: OBJECTIVE
  This study aimed to investigate the prevalence of a reduced glomerular filtration rate (GFR) with and without albuminuria and its ability to predict cardiac events in asymptomatic diabetic patients undergoing stress-rest thallium-201 myocardial perfusion single-photon emission computed tomography.
  
  
  BACKGROUND
  Diabetic patients have a higher prevalence of asymptomatic coronary heart disease. Therefore, identifying predictors of cardiac events in asymptomatic diabetic patients is needed.
  
  
  METHODS
  In 269 asymptomatic patients, baseline evaluation included diabetes-related complications, including creatinine clearance (CrCl) and albuminuria. During follow-up (mean 2.3 +/- 1.0 years), all cardiac events were recorded.
  
  
  RESULTS
  Seventy-seven patients (29%) had a reduced GFR defined by CrCl <60 ml/min/1.73 m(2). Compared with the 177 patients with CrCl >/=60 ml/min/1.73 m(2), the reduced GFR group was older (p < 0.0001), had a longer duration of diabetes (p = 0.002), and had a higher prevalence of albuminuria (p = 0.04). Nevertheless, 35% of the reduced GFR group had normoalbuminuria. Patients with reduced GFR had a significant two-fold increase in total cardiac events (unstable angina, nonfatal myocardial infarction, and cardiac procedures) (25% vs. 13%, p = 0.019), and multivariate analysis found that reduced GFR was an independent predictor of cardiac events (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.1 to 4.46). Other independent predictors of cardiac events included stress-induced abnormal myocardial perfusion imaging (OR 3.1, 95% CI 1.3 to 7.5), an electrocardiographic ischemic response (OR 2.7, 95% CI 1.01 to 7.14), and peripheral artery disease (OR 2.1, 95% CI 1.05 to 4.23); however, albuminuria was not.
  
  
  CONCLUSIONS
  A reduced GFR was common in our group of asymptomatic diabetic patients and was associated with a two-fold increase in cardiac events. Multivariate analysis found that reduced GFR independent of albuminuria was a significant predictor of cardiac events.
authors.affiliation: Metabolic Unit, Kaplan Medical Center, affiliated with Hadassah and the Hebrew University School of Medicine, Rehovot, Israel. knobler@inter.net.il
authors.forename: Hilla
authors.initials: H
authors.lastname: Knobler
authors.forename: Taiba
authors.initials: T
authors.lastname: Zornitzki
authors.forename: Shiraz
authors.initials: S
authors.lastname: Vered
authors.forename: Michael
authors.initials: M
authors.lastname: Oettinger
authors.forename: Rosa
authors.initials: R
authors.lastname: Levy
authors.forename: Abraham
authors.initials: A
authors.lastname: Caspi
authors.forename: David
authors.initials: D
authors.lastname: Faraggi
authors.forename: Shay
authors.initials: S
authors.lastname: Livschitz
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000503:physiopathology*; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D003404:Creatinine / Q000097:blood; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000503:physiopathology; D012306:Risk; D012307:Risk Factors; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D013794:Thallium Radioisotopes; D003404:Creatinine