title: Subnormal Estimated Glomerular Filtration Rate Strongly Predict Incident Cardiovascular Events in Type 2 Diabetic Chinese Population With Normoalbuminuria.
abstract: No study has evaluated whether subnormal estimated glomerular filtration rate (eGFR) (between 61 and 90 mL/min) and high normal albumin-creatinine ratio (ACR) (<30 mg/g) are associated with cardiovascular (CV) events and mortality in type 2 diabetic (T2DM) patients with normoalbuminuria.We observed a longitudinal cohort study of 1291 T2DM patients with normoalbuminuria who were receiving intensified multifactorial treatment from 2004 to 2008. Cox regression models were used to evaluate eGFR and ACR as the risk factors of major CV events (nonfatal myocardial infarction and stroke) and mortality.During the 4-year period, 56 patients died and 159 patients developed major CV events. We found eGFR, but not ACR, to be associated with major CV events. Compared to those with eGFR higher than 90 mL/min, patients with subnormal eGFR (HR: 3.133, 1.402-7.002, P = 0.005) were at greater risk of incident major CV events. Extremely low eGFR (<30 mL/min) was associated with mortality only in patients under 65 years old.Subnormal eGFR was a strong predictor of major CV events in diabetic patients with normoalbuminuria. Normoalbuminuric diabetic patients with subnormal eGFR may need intensive CV risk factor intervention to prevent and treat CV events.
authors.affiliation: From the Department of Ophthalmology, National Taiwan University Hospital, Taipei (Y-TH); The Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua (J-FK, S-LS, M-CH); The Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung (J-FC); The Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital; Faculty of Medicine College of Medicine; Faculty of Renal Care College of Medicine, Kaohsiung Medical University, Kaohsiung (H-CC); and The Graduate Institute of Integrated Medicine, China Medical University, Taichung (M-CH).
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Hsieh
authors.forename: Jeng-Fu
authors.initials: JF
authors.lastname: Kuo
authors.forename: Shih-Li
authors.initials: SL
authors.lastname: Su
authors.forename: Jung-Fu
authors.initials: JF
authors.lastname: Chen
authors.forename: Hung-Chun
authors.initials: HC
authors.lastname: Chen
authors.forename: Ming-Chia
authors.initials: MC
authors.lastname: Hsieh
mesh_terms: D000419:Albuminuria / Q000652:urine; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality; D003404:Creatinine / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D013624:Taiwan / Q000453:epidemiology
chemical_list: D003404:Creatinine