Association of estimated glomerular filtration rate and urine albumin-to-creatinine ratio with incidence of cardiovascular diseases and mortality in chinese patients with type 2 diabetes mellitus - a population-based retrospective cohort study.
Estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) are renal markers associated with risks of cardiovascular diseases (CVD) and all-cause mortality in diabetic patients. This study aims to quantify such risks in Chinese diabetic patients based on eGFR and UACR.



This was a territory-wide retrospective cohort study on primary care diabetic patients with documented eGFR and UACR but without baseline CVD in 2008/2009. They were followed up till 2013 on CVD events and mortality. Associations between eGFR/UACR and incidence of CVD/mortality were evaluated by multivariable Cox proportional models adjusted with socio-demographic and clinical characteristics.



The data of 66,311 patients who had valid baseline eGFR and UACR values were analysed. The risks of CVD events and mortality increased exponentially with the decrease in eGFR, with a hazard ratio (HR) increasing from 1.63 to 4.55 for CVD, and from 1.70 to 9.49 for mortality, associated with Stage 3 to 5 CKD, compared to Stage 1 CKD. UACR showed a positive linear association with CVD events and mortality. Microalbuminuria was associated with a HR of 1.58 and 2.08 for CVD and mortality in male (1.48 and 1.79 for female), respectively, compared to no microalbuminuria. Male patients with UACR 1-1.4 mg/mmol and eGFR ≥90 ml/min/1.73 m2(60-89 ml/min/1.73 m2) had a HR of 1.25 (1.43) for CVD. Female patients with UACR 2.5-3.4 mg/ml and eGFR ≥90 ml/min/1.73 m2(60-89 ml/min/1.73 m2) had a HR of 1.45 (1.65) for CVD.



Risks of CVD events and mortality increased exponentially with eGFR drop, while UACR showed positive predictive linear relationships, and the risks started even in high-normal albuminuria. UACR-based HR was further modified according to eGFR level, with risk progressed with CKD stage. Combining eGFR and UACR level was more accurate in predicting risk of CVD/mortality. The findings call for more aggressive screening and intervention of microalbuminuria in diabetic patients.
Department of Family Medicine and Primary Care, the University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong. cfsc@hku.hk.
Colman Siu Cheung
CS
Fung
Department of Family Medicine and Primary Care, the University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong.
Eric Yuk Fai
EY
Wan
Department of Family Medicine and Primary Care, the University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong.
Anca Ka Chun
AK
Chan
Department of Family Medicine and Primary Care, the University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong.
Cindy Lo Kuen
CL
Lam
D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000453:epidemiology* / Q000378:metabolism; D044466:Asian People; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000378:metabolism / Q000401:mortality; D002681:China; D015331:Cohort Studies; D003404:Creatinine / Q000652:urine*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000378:metabolism; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D003404:Creatinine
Cardiovascular diseases; Diabetes mellitus; Estimated glomerular filtration rate (eGFR); Mortality; Primary care; Urine albumin-to-creatinine ratio (UACR)