Mathilde Monseu1, Elise Gand2, Pierre-Jean Saulnier3, Stéphanie Ragot3, Xavier Piguel2, Philippe Zaoui4, Vincent Rigalleau5, Richard Marechaud6, Ronan Roussel7, Samy Hadjadj8, Jean-Michel Halimi9. 1. Université de Poitiers, CIC1402, Poitiers, France Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France INSERM, CIC1402, Poitiers, France Service d'Endocrinologie, CHU de Poitiers, Pôle DUNE, Poitiers, France. 2. Service d'Endocrinologie, CHU de Poitiers, Pôle DUNE, Poitiers, France. 3. Université de Poitiers, CIC1402, Poitiers, France Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France INSERM, CIC1402, Poitiers, France. 4. Service Néphrologie, Dialyse et Transplantation, CHU de Grenoble, La Tronche, France Faculté de Médecine, Domaine de la Merci, Université Joseph Fourrier, Grenoble, France. 5. Service d'Endocrinologie, Diabétologie, Maladies Métaboliques et Nutrition, CHU de Bordeaux, Pessac, France. 6. Service d'Endocrinologie, CHU de Poitiers, Pôle DUNE, Poitiers, France Faculté de Médecine et Pharmacie, Université de Poitiers, Poitiers, France. 7. Université Paris 7 Denis Diderot, U695, Paris, France Service d'Endocrinologie, Diabétologie, Nutrition, Groupe Hospitalier Bichat Claude Bernard, Assistance Public-Hôpitaux de Paris, Paris, France. 8. Université de Poitiers, CIC1402, Poitiers, France Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France INSERM, CIC1402, Poitiers, France Service d'Endocrinologie, CHU de Poitiers, Pôle DUNE, Poitiers, France Faculté de Médecine et Pharmacie, Université de Poitiers, Poitiers, France INSERM, U1082, Poitiers, France. 9. Service de Néphrologie, CHU de Tours, Tours, France Université François-Rabelais, EA4245, Faculté de Médecine, Tours, France halimi@med.univ-tours.fr.
Abstract
OBJECTIVE: Subjects with diabetes are prone to the development of cardiovascular and noncardiovascular complications. In separate studies, acute kidney injury (AKI), albuminuria, and low estimated glomerular filtration rate (eGFR) were shown to predict adverse outcomes, but, when considered together, their respective prognostic value is unknown. RESEARCH DESIGN AND METHODS: Patients with type 2 diabetes consecutively recruited in the SURDIAGENE cohort were prospectively followed up for major diabetes-related events, as adjudicated by an independent committee: death (with cause), major cardiovascular events (myocardial infarction, stroke, congestive heart failure, amputation, and arterial revascularization), and renal failure (i.e., sustained doubling of serum creatinine level or end-stage renal disease). RESULTS: Intrahospital AKI occurred in 411 of 1,371 patients during the median follow-up period of 69 months. In multivariate analyses, AKI was significantly associated with cardiovascular and noncardiovascular death, including cancer-related death. In multivariate analyses, AKI was a powerful predictor of major adverse cardiovascular events, heart failure requiring hospitalization, myocardial infarction, stroke, lower-limb amputation or revascularization, and carotid artery revascularization. AKI, eGFR, and albuminuria, even when simultaneously considered in multivariate models, predicted all-cause and cardiovascular deaths. All three renal biomarkers were also prognostic of most adverse outcomes and of the risk of renal failure. CONCLUSIONS: AKI, low eGFR, and elevated albuminuria, separately or together, are compelling biomarkers of major adverse outcomes and death in diabetes.
OBJECTIVE: Subjects with diabetes are prone to the development of cardiovascular and noncardiovascular complications. In separate studies, acute kidney injury (AKI), albuminuria, and low estimated glomerular filtration rate (eGFR) were shown to predict adverse outcomes, but, when considered together, their respective prognostic value is unknown. RESEARCH DESIGN AND METHODS: Patients with type 2 diabetes consecutively recruited in the SURDIAGENE cohort were prospectively followed up for major diabetes-related events, as adjudicated by an independent committee: death (with cause), major cardiovascular events (myocardial infarction, stroke, congestive heart failure, amputation, and arterial revascularization), and renal failure (i.e., sustained doubling of serum creatinine level or end-stage renal disease). RESULTS: Intrahospital AKI occurred in 411 of 1,371 patients during the median follow-up period of 69 months. In multivariate analyses, AKI was significantly associated with cardiovascular and noncardiovascular death, including cancer-related death. In multivariate analyses, AKI was a powerful predictor of major adverse cardiovascular events, heart failure requiring hospitalization, myocardial infarction, stroke, lower-limb amputation or revascularization, and carotid artery revascularization. AKI, eGFR, and albuminuria, even when simultaneously considered in multivariate models, predicted all-cause and cardiovascular deaths. All three renal biomarkers were also prognostic of most adverse outcomes and of the risk of renal failure. CONCLUSIONS: AKI, low eGFR, and elevated albuminuria, separately or together, are compelling biomarkers of major adverse outcomes and death in diabetes.
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