title: Acute Kidney Injury Predicts Major Adverse Outcomes in Diabetes: Synergic Impact With Low Glomerular Filtration Rate and Albuminuria.
abstract: OBJECTIVE
  Subjects with diabetes are prone to the development of cardiovascular and noncardiovascular complications. In separate studies, acute kidney injury (AKI), albuminuria, and low estimated glomerular filtration rate (eGFR) were shown to predict adverse outcomes, but, when considered together, their respective prognostic value is unknown.
  
  
  METHODS
  Patients with type 2 diabetes consecutively recruited in the SURDIAGENE cohort were prospectively followed up for major diabetes-related events, as adjudicated by an independent committee: death (with cause), major cardiovascular events (myocardial infarction, stroke, congestive heart failure, amputation, and arterial revascularization), and renal failure (i.e., sustained doubling of serum creatinine level or end-stage renal disease).
  
  
  RESULTS
  Intrahospital AKI occurred in 411 of 1,371 patients during the median follow-up period of 69 months. In multivariate analyses, AKI was significantly associated with cardiovascular and noncardiovascular death, including cancer-related death. In multivariate analyses, AKI was a powerful predictor of major adverse cardiovascular events, heart failure requiring hospitalization, myocardial infarction, stroke, lower-limb amputation or revascularization, and carotid artery revascularization. AKI, eGFR, and albuminuria, even when simultaneously considered in multivariate models, predicted all-cause and cardiovascular deaths. All three renal biomarkers were also prognostic of most adverse outcomes and of the risk of renal failure.
  
  
  CONCLUSIONS
  AKI, low eGFR, and elevated albuminuria, separately or together, are compelling biomarkers of major adverse outcomes and death in diabetes.
authors.affiliation: Université de Poitiers, CIC1402, Poitiers, France Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France INSERM, CIC1402, Poitiers, France Service d'Endocrinologie, CHU de Poitiers, Pôle DUNE, Poitiers, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Monseu
authors.affiliation: Service d'Endocrinologie, CHU de Poitiers, Pôle DUNE, Poitiers, France.
authors.forename: Elise
authors.initials: E
authors.lastname: Gand
authors.affiliation: Université de Poitiers, CIC1402, Poitiers, France Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France INSERM, CIC1402, Poitiers, France.
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Saulnier
authors.affiliation: Université de Poitiers, CIC1402, Poitiers, France Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France INSERM, CIC1402, Poitiers, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Ragot
authors.affiliation: Service d'Endocrinologie, CHU de Poitiers, Pôle DUNE, Poitiers, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Piguel
authors.affiliation: Service Néphrologie, Dialyse et Transplantation, CHU de Grenoble, La Tronche, France Faculté de Médecine, Domaine de la Merci, Université Joseph Fourrier, Grenoble, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Zaoui
authors.affiliation: Service d'Endocrinologie, Diabétologie, Maladies Métaboliques et Nutrition, CHU de Bordeaux, Pessac, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Rigalleau
authors.affiliation: Service d'Endocrinologie, CHU de Poitiers, Pôle DUNE, Poitiers, France Faculté de Médecine et Pharmacie, Université de Poitiers, Poitiers, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Marechaud
authors.affiliation: Université Paris 7 Denis Diderot, U695, Paris, France Service d'Endocrinologie, Diabétologie, Nutrition, Groupe Hospitalier Bichat Claude Bernard, Assistance Public-Hôpitaux de Paris, Paris, France.
authors.forename: Ronan
authors.initials: R
authors.lastname: Roussel
authors.affiliation: Université de Poitiers, CIC1402, Poitiers, France Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France INSERM, CIC1402, Poitiers, France Service d'Endocrinologie, CHU de Poitiers, Pôle DUNE, Poitiers, France Faculté de Médecine et Pharmacie, Université de Poitiers, Poitiers, France INSERM, U1082, Poitiers, France.
authors.forename: Samy
authors.initials: S
authors.lastname: Hadjadj
authors.affiliation: Service de Néphrologie, CHU de Tours, Tours, France Université François-Rabelais, EA4245, Faculté de Médecine, Tours, France halimi@med.univ-tours.fr.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Halimi
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications* / Q000503:physiopathology; D000368:Aged; D000419:Albuminuria / Q000150:complications* / Q000503:physiopathology; D015415:Biomarkers; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors
chemical_list: D015415:Biomarkers