The relationship between urinary albumin excretion, cardiovascular outcomes and total mortality among a large cohort of insulin-treated patients with type 2 diabetes in routine primary care practices

Anyanwagu, Uchenna; Donnelly, Richard; Idris, Iskandar

Abstract

© The Author(s) 2018. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. BACKGROUND: Albuminuria is a recognized diagnostic and prognostic marker of chronic kidney disease and cardiovascular (CV) risk but the well-known relationship between increments in urinary albumin:creatinine ratio (UACR) and CV outcomes and mortality has not been fully explored in insulin-treated patients with type 2 diabetes (T2D) in routine clinical care. METHODS: We investigated data for insulin users with T2D from UK general practices between 2007 and 2014. The UACR at the time of insulin initiation was measured and categorized as 300 mg/g. Patients were followed up for 5 years or the earliest occurrence of all-cause mortality, non-fatal myocardial infarction or stroke. Cox proportional hazards models were fitted to estimate the risk of a composite of these events. RESULTS: A total of 12 725 patients with T2D (mean age 58.6 ± 13.8 years, mean haemoglobin A1c 8.7 ± 1.8%) initiating insulin therapy between 2007 and 2014 met the inclusion criteria. Compared with patients whose ACR levels at insulin initiation were 300 mg/g, respectively, after a follow-up period of 5 years. The ACR category on its own did not predict risk of all-cause mortality. CONCLUSIONS: This study shows that in patients with T2D on insulin therapy, increased urinary ACR is independently associated with an increased risk of major adverse CV events and all-cause mortality.

Citation

Anyanwagu, U., Donnelly, R., & Idris, I. (2020). The relationship between urinary albumin excretion, cardiovascular outcomes and total mortality among a large cohort of insulin-treated patients with type 2 diabetes in routine primary care practices. Nephrology Dialysis Transplantation, 35(3), 471-477. https://doi.org/10.1093/ndt/gfy258

• Journal Article Type: Article
• Acceptance Date: Jul 9, 2018
• Online Publication Date: Aug 28, 2018
• Publication Date: Mar 1, 2020
• Deposit Date: Aug 31, 2018
• Publicly Available Date: Aug 29, 2019
• Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
• Print ISSN: 0931-0509
• Electronic ISSN: 1460-2385
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 35
• Issue: 3
• Pages: 471-477
• DOI: https://doi.org/10.1093/ndt/gfy258
• Keywords: Nephrology; Transplantation
• Public URL: https://nottingham-repository.worktribe.com/output/1054356
• Publisher URL: https://academic.oup.com/ndt/advance-article/doi/10.1093/ndt/gfy258/5086072