Joint relationship between renal function and proteinuria on mortality of patients with type 2 diabetes: the Taichung Diabetes Study.
BACKGROUND
Estimated glomerular filtration rate (eGFR) is a powerful predictor of mortality in diabetic patients with limited proteinuria data. In this study, we tested whether concomitant proteinuria increases the risk of mortality among patients with type 2 diabetes.


METHODS
Participants included 6523 patients > 30 years with type 2 diabetes who were enrolled in a management program of a medical center before 2007. Renal function was assessed by eGFR according to the Modification of Diet in Renal Disease Study equation for Chinese. Proteinuria was assessed by urine dipstick.


RESULTS
A total of 573 patients (8.8%) died over a median follow-up time of 4.91 years (ranging from 0.01 year to 6.42 years). The adjusted expanded cardiovascular disease (CVD)-related mortality rates among patients with proteinuria were more than three folds higher for those with an eGFR of 60 mL/min/1.73 m2 or less compared with those with an eGFR of 90 mL/min/1.73 m2 or greater [hazard ratio, HR, 3.15 (95% confidence interval, CI, 2.0-5.1)]. The magnitude of adjusted HR was smaller in patients without proteinuria [1.98 (95% CI, 1.1-3.7)]. An eGFR of 60 mL/min/1.73 m2 to 89 mL/min/1.73 m2 significantly affected all-cause mortality and mortality from expanded CVD-related causes only in patients with proteinuria. Similarly, proteinuria affected all outcomes only in patients with an eGFR of <60 mL/min/1.73 m2.


CONCLUSIONS
The risks of all-cause mortality, as well as expanded and non-expanded mortality from CVD-related causes associated with proteinuria or an eGFR of 90 mL/min/1.73 m2 or greater are independently increased. Therefore, the use of proteinuria measurements with eGFR increases the precision of risk stratification for mortality.
Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
Cheng-Chieh
CC
Lin
Ching-Chu
CC
Chen
Pei-Tseng
PT
Kung
Chia-Ing
CI
Li
Sing-Yu
SY
Yang
Chiu-Shong
CS
Liu
Wen-Yuan
WY
Lin
Cheng-Chun
CC
Lee
Tsai-Chung
TC
Li
Sharon L R
SL
Kardia
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality / Q000503:physiopathology; D002423:Cause of Death; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality* / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011507:Proteinuria / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D011934:Reagent Strips; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016482:Urinalysis / Q000295:instrumentation
D011934:Reagent Strips