title: Risk of mortality associated to chronic kidney disease in patients with type 2 diabetes mellitus: a 13-year follow-up.
abstract: OBJECTIVE
  Our aim was to assess the usefulness of glomerular filtration rate (GFR) and urinary albumin excretion (UAE) to predict the risk of mortality in patients with type 2 diabetes mellitus.
  
  
  METHODS
  This is a prospective cohort study in patients with type 2 diabetes mellitus. Clinical end-point was mortality rate. GFR was measured in ml/min/1.73 m2 and stratified in 3 categories (≥60; 45-59; <45); UAE was measured in mg/24hours and was also stratified in 3 categories (<30; 30-300; >300). Mortality rates were reported per 1000 patient-years. Cox regression models were used to predict mortality risk associated with combined GFR and UAE. The predictive power was estimated with C-Harrell statistic.
  
  
  RESULTS
  A total of 453 patients (39.3% males), aged 64.9 (SD 9.3) years were included; mean diabetes duration was 10.4 (SD 7.5) years. Median follow-up was 13 years. Total mortality rate was 39.5/1000. The progressive increase in mortality in the successive categories of GFR and UAE was statistically significant (P<.001). In a multivariable analysis, UAE (HR30-300=1.02 and HR>300=2.83; X2=11.6; P =.003) and GFR (HR45-59=1.34 and HR<45=1.84; X2=6.4; P =.041) were independent predictors for mortality, with no significant interaction. Simultaneous inclusion of GFR and UAE improved the predictive power of models (C-Harrell 0.741 vs. 0.726; P =.045).
  
  
  CONCLUSIONS
  GFR and UAE are independent predictors for mortality in type 2 diabetic patients and do not show a statistically significant interaction.
authors: Servicio de Endocrinología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España. Electronic address: jagimeno@salud.aragon.es.
authors: José Antonio
authors: JA
authors: Gimeno-Orna
authors: Servicio de Endocrinología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
authors: Yolanda
authors: Y
authors: Blasco-Lamarca
authors: Servicio de Nefrología, Hospital Comarcal de Alcañiz, Alcañiz, Teruel, España.
authors: Belén
authors: B
authors: Campos-Gutierrez
authors: Servicio de Cardiología, Hospital Universitario de Burgos, Burgos, España.
authors: Edmundo
authors: E
authors: Molinero-Herguedas
authors: Servicio de Nefrología, Hospital Universitario Miguel Servet, Zaragoza, España.
authors: Luis Miguel
authors: LM
authors: Lou-Arnal
authors: Servicio de Endocrinología, Hospital Royo Villanova, Zaragoza, España.
authors: Blanca
authors: B
authors: García-García
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000453:epidemiology / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003928:Diabetic Nephropathies / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000401:mortality*; D012306:Risk
keywords: Chronic renal failure; Diabetes mellitus tipo 2; Insuficiencia renal crónica; Mortalidad; Mortality; Type 2 diabetes mellitus