title: Albuminuria and kidney function independently predict cardiovascular and renal outcomes in diabetes.
abstract: There are limited data regarding whether albuminuria and reduced estimated GFR (eGFR) are separate and independent risk factors for cardiovascular and renal events among individuals with type 2 diabetes. The Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study examined the effects of routine BP lowering on adverse outcomes in type 2 diabetes. We investigated the effects of urinary albumin-to-creatinine ratio (UACR) and eGFR on the risk for cardiovascular and renal events in 10,640 patients with available data. During an average 4.3-yr follow-up, 938 (8.8%) patients experienced a cardiovascular event and 107 (1.0%) experienced a renal event. The multivariable-adjusted hazard ratio for cardiovascular events was 2.48 (95% confidence interval 1.74 to 3.52) for every 10-fold increase in baseline UACR and 2.20 (95% confidence interval 1.09 to 4.43) for every halving of baseline eGFR, after adjustment for regression dilution. There was no evidence of interaction between the effects of higher UACR and lower eGFR. Patients with both UACR >300 mg/g and eGFR <60 ml/min per 1.73 m(2) at baseline had a 3.2-fold higher risk for cardiovascular events and a 22.2-fold higher risk for renal events, compared with patients with neither of these risk factors. In conclusion, high albuminuria and low eGFR are independent risk factors for cardiovascular and renal events among patients with type 2 diabetes.
authors.affiliation: George Institute for International Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Ninomiya
authors.forename: Vlado
authors.initials: V
authors.lastname: Perkovic
authors.forename: Bastiaan E
authors.initials: BE
authors.lastname: de Galan
authors.forename: Sophia
authors.initials: S
authors.lastname: Zoungas
authors.forename: Avinesh
authors.initials: A
authors.lastname: Pillai
authors.forename: Meg
authors.initials: M
authors.lastname: Jardine
authors.forename: Anushka
authors.initials: A
authors.lastname: Patel
authors.forename: Alan
authors.initials: A
authors.lastname: Cass
authors.forename: Bruce
authors.initials: B
authors.lastname: Neal
authors.forename: Neil
authors.initials: N
authors.lastname: Poulter
authors.forename: Carl-Erik
authors.initials: CE
authors.lastname: Mogensen
authors.forename: Mark
authors.initials: M
authors.lastname: Cooper
authors.forename: Michel
authors.initials: M
authors.lastname: Marre
authors.forename: Bryan
authors.initials: B
authors.lastname: Williams
authors.forename: Pavel
authors.initials: P
authors.lastname: Hamet
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.forename: Stephen
authors.initials: S
authors.lastname: Macmahon
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000453:epidemiology*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D051437:Renal Insufficiency / Q000453:epidemiology; D012307:Risk Factors