Individual and combined relationship between reduced eGFR and/or increased urinary albumin excretion rate with mortality risk among insulin treated patients with Type 2 diabetes in routine practice

Anyanwagu, U.; Donnelly, Richard; Idris, Iskandar

Abstract

Background: Low estimated glomerular filtration rate (eGFR) and increased urinary albumin-to-creatinine ratio (ACR) are well-recognised prognostic markers of cardiovascular (CV) risk, but their individual and combine relationship with CV disease and total mortality among insulin-treated Type 2 Diabetes (T2D) patients in routine clinical care is unclear.
Methods: We analysed data for insulin users with T2D from UK general practices between 2007 and 2014 and examined the association between mortality rates and CKD [categorised by low eGFR ((less 60mL/min/1.73 m2); high eGFR (≥60mL/min/1.73 m2); low ACR (less 300mg/g); and high ACR (≥300mg/g) at insulin initiation] after a 5-year follow-up period using Cox proportional hazard models.
Results: A total of 18,227 patients were identified (mean age: 61.5±13.8 years, mean HbA1c: 8.6±1.8%). After adjusting for confounders, when compared to adults on insulin therapy with an eGFR less 60 and an ACR ≥300 (low eGFR + high ACR) after a follow up period of 5 years, patients with an eGFR less 60 and an ACR less 300 (low eGFR + low ACR) had a 6% lower mortality rate (aHR: 0.94; 95%CI: 0.79 to1.12); those with an eGFR >60 and an ACR ≥300 (high eGFR + high ACR) had a 20% lower mortality rate (aHR: 0.80; 95%CI: 0.68 to 0.96); and those with an eGFR >60 and an ACR less 300 (high eGFR + low ACR) had the lowest death rate (28% less; aHR: 0.72; 95%CI: 0.59 to 0.87 ).
Conclusion: This study shows that among a large cohort of insulin-treated T2D patients in routine practice, the combination of reduced eGFR with increased ACR was associated with the greatest risk of premature death, followed closely by those with reduced eGFR and normal ACR levels. Adoption of aggressive CV risk management strategies to reduce mortality in patients with a low eGFR and albuminuria is essential in these high risk patients with T2D.

Citation

Anyanwagu, U., Donnelly, R., & Idris, I. (2019). Individual and combined relationship between reduced eGFR and/or increased urinary albumin excretion rate with mortality risk among insulin treated patients with Type 2 diabetes in routine practice. Kidney Diseases, 5(2), 91–99. https://doi.org/10.1159/000493731

• Journal Article Type: Article
• Acceptance Date: Sep 12, 2018
• Online Publication Date: Nov 16, 2018
• Publication Date: 2019-03
• Deposit Date: Sep 12, 2018
• Publicly Available Date: Nov 17, 2019
• Print ISSN: 2296-9381
• Publisher: Karger Publishers
• Peer Reviewed: Peer Reviewed
• Volume: 5
• Issue: 2
• Pages: 91–99
• DOI: https://doi.org/10.1159/000493731
• Public URL: https://nottingham-repository.worktribe.com/output/1072306
• Publisher URL: https://www.karger.com/Article/Pdf/493731