Post-Discharge Worsening Renal Function in Patients with Type 2 Diabetes and Recent Acute Coronary Syndrome.
Worsening renal function during hospitalization for an acute coronary syndrome is strongly predictive of in-hospital and long-term outcome. However, the role of post-discharge worsening renal function has never been investigated in this setting.



We considered the placebo cohort of the AleCardio trial comparing aleglitazar with standard medical therapy among patients with type 2 diabetes mellitus and a recent acute coronary syndrome. Patients who had died or had been admitted to hospital for heart failure before the 6-month follow-up, as well as patients without complete renal function data, were excluded, leaving 2776 patients for the analysis. Worsening renal function was defined as a >20% reduction in estimated glomerular filtration rate from discharge to 6 months, or progression to macroalbuminuria. The Cox regression analysis was used to determine the prognostic impact of 6-month renal deterioration on the composite of all-cause death and hospitalization for heart failure.



Worsening renal function occurred in 204 patients (7.34%). At a median follow-up of 2 years the estimated rates of death and hospitalization for heart failure per 100 person-years were 3.45 (95% confidence interval [CI], 2.46-6.36) for those with worsening renal function, versus 1.43 (95% CI, 1.14-1.79) for patients with stable renal function. At the adjusted analysis worsening renal function was associated with the composite endpoint (hazard ratio 2.65; 95% CI, 1.57-4.49; P <.001).



Post-discharge worsening renal function is not infrequent among patients with type 2 diabetes and acute coronary syndromes with normal or mildly depressed renal function, and is a strong predictor of adverse cardiovascular events.
Unità di Terapia Intensiva Cardiologica, ASST Grande Ospedale Metropolitano Niguarda Ca' Granda, Milano, Italy. Electronic address: nuccia.morici@ospedaleniguarda.it.
Nuccia
N
Morici
Dipartimento Cardiovascolare, Ospedale A. Manzoni, Lecco, Italy.
Stefano
S
Savonitto
Division of Nephrology, Humanitas Clinical Research Center, Rozzano (Milano), Italy.
Claudio
C
Ponticelli
Julius Center for Health Sciences and Primary Care and Julius Clinical, Utrecht, the Netherlands.
Ilse C
IC
Schrieks
Montreal Health Innovations Coordinating Center, Quebec, Canada.
Anna
A
Nozza
Cardiology Unit, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden.
Francesco
F
Cosentino
Montreal Heart Institute, Université de Montréal, Quebec, Canada.
Barbara E
BE
Stähli
Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
Pasquale
P
Perrone Filardi
Veterans Affairs Medical Center and University of Colorado School of Medicine, Denver.
Gregory G
GG
Schwartz
Cardiology Unit, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden.
Linda
L
Mellbin
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Ohio.
A Michael
AM
Lincoff
Montreal Health Innovations Coordinating Center, Quebec, Canada; Montreal Heart Institute, Université de Montréal, Quebec, Canada.
Jean-Claude
JC
Tardif
Julius Center for Health Sciences and Primary Care and Julius Clinical, Utrecht, the Netherlands.
Diederick E
DE
Grobbee
D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D000368:Aged; D000419:Albuminuria; D000704:Analysis of Variance; D015415:Biomarkers; D002423:Cause of Death; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D048909:Diabetes Complications / Q000401:mortality*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D008297:Male; D010080:Oxazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010351:Patient Discharge / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention; D047492:Peroxisome Proliferator-Activated Receptors / Q000008:administration & dosage / Q000009:adverse effects / Q000819:agonists / Q000627:therapeutic use; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D012307:Risk Factors; D013876:Thiophenes / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D015415:Biomarkers; D010080:Oxazoles; D047492:Peroxisome Proliferator-Activated Receptors; D013876:Thiophenes; C542437:aleglitazar; D003404:Creatinine
Acute coronary syndrome; Diabetes mellitus; Worsening renal function