Chronic kidney disease and mortality risk among older patients with type 2 diabetes mellitus (ZODIAC-24).
OBJECTIVE
to investigate the association between a decreased estimated glomerular filtration rate (eGFR), albuminuria and mortality in elderly patients with type 2 diabetes mellitus (T2DM).


METHODS
prospective observational cohort study.


METHODS
primary care.


METHODS
eight hundred and ten patients, ≥65 years with T2DM. Analyses were performed in age strata: 65-75 (n = 471), >75 (n = 339) years.


METHODS
Cox proportional hazard modelling was used to investigate the association between eGFR, albuminuria and all-cause and cardiovascular mortality after a median follow-up of 9.8 years.


RESULTS
an eGFR <45 and 45-60 ml/min/1.73 m(2) is associated with increased cardiovascular mortality in patients of 65-75 years, hazard ratio (HR): 3.29 (1.58-6.86) and 1.78 (1.09-2.90), respectively; in those >75 years increased cardiovascular mortality was observed when eGFR was <45 ml/min/1.73 m(2): 2.42 (1.47-3.69). Compared with patients of 65-75 years, an eGFR >60 ml/min/1.73 m(2) and normo-albuminuria, fully adjusted HRs for cardiovascular mortality were 2.26 (1.04-4.92) and 4.86 (2.33-10.15) for those aged 65-75 years, an eGFR of 45-60 ml/min/1.73 m(2) and normo-albuminuria or albuminuria, respectively; HRs were 1.33 (0.67-2.66) and 2.01 (1.02-3.94), respectively, for those >75 years.


CONCLUSIONS
an eGFR of 45-60 ml/min/1.73 m(2) in T2DM patients is associated with increased mortality in patients aged 65-75 years but not in those >75 years. Albuminuria is associated with increased mortality in patients >65 years.
Diabetes Centre, Isala Clinics, Zwolle, The Netherlands. i.drion@isala.nl
Iefke
I
Drion
Kornelis J J
KJ
van Hateren
Hanneke
H
Joosten
Alaa
A
Alkhalaf
Klaas H
KH
Groenier
Nanne
N
Kleefstra
Jack F M
JF
Wetzels
Henk J G
HJ
Bilo
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000419:Albuminuria / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000401:mortality*; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality*; D003928:Diabetic Nephropathies / Q000097:blood / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000378:metabolism / Q000503:physiopathology; D007674:Kidney Diseases / Q000097:blood / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors
D015415:Biomarkers; D003404:Creatinine