Stéphanie Ragot1, Pierre-Jean Saulnier2, Gilberto Velho3, Elise Gand4, Astrid de Hauteclocque5, Yousri Slaoui6, Louis Potier3, Philippe Sosner7, Jean-Michel Halimi8, Philippe Zaoui9, Vincent Rigalleau10, Frederic Fumeron3, Ronan Roussel3, Michel Marre3, Samy Hadjadj11. 1. INSERM CIC 1402, Poitiers, France Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France stephanie.ragot@univ-poitiers.fr. 2. INSERM CIC 1402, Poitiers, France Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France. 3. INSERM UMRS1138, Centre de Recherche des Cordeliers, Paris, France Département d'Endocrinologie, Diabétologie, et Nutrition, DHU FIRE, Hôpital Bichat, AP-HP, Paris, France. 4. Pôle DUNE, CHU de Poitiers, Poitiers, France. 5. INSERM CIC 1402, Poitiers, France. 6. Laboratoire de Mathématiques et Applications, Université de Poitiers, Poitiers, France. 7. Complexe Médico-Sportif Mon Stade, Paris, France Laboratoire MOVE (EA 6314), Université de Poitiers, Poitiers, France. 8. Service Néphrologie Immunologie Clinique, CHU de Tours, Tours, France Cellules Dendritiques, Immunomodulation, et Greffes (EA 4245), Université François Rabelais, Tours, France. 9. Service Néphrologie, Dialyse, et Transplantation, CHU de Grenoble, Grenoble, France Faculté de Médecine, Université Joseph Fournier, Grenoble, France. 10. Service Nutrition-Diabétologie, CHU Haut-Lévêque, Pessac, France Faculté de Médecine, Université Victor Segalen, Bordeaux, France. 11. INSERM CIC 1402, Poitiers, France UFR Médecine Pharmacie, Université de Poitiers, Poitiers, France Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France INSERM U1082 IRTOMIT, Poitiers, France.
Abstract
OBJECTIVE: The pattern of renal function decline prior to cardiovascular (CV) events in type 2 diabetes is not well known. Our aim was to describe the association between renal function trajectories and the occurrence of a CV event. RESEARCH DESIGN AND METHODS: We considered patients with type 2 diabetes from the SURDIAGENE (Survie, Diabete de type 2 et Genetique) study (discovery cohort) and the DIABHYCAR (Non-Insulin-Dependent Diabetes, Hypertension, Microalbuminuria or Proteinuria, Cardiovascular Events, and Ramipril) study (replication cohort). Global patterns of estimated glomerular filtration rate (eGFR) (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]) and serum creatinine (SCr) prior to a major CV event (MACE) or last update were determined using a linear mixed-effects model and annual individual slopes computed by simple linear regression. RESULTS: In the 1,040 participants of the discovery cohort, establishment of global patterns including 22,227 SCr over 6.3 years of follow-up showed an annual eGFR decline and an annual SCr increase that were significantly greater in patients with MACE compared with patients without (-3.0 and -1.7 mL/min/1.73 m(2)/year and +10.7 and +4.0 μmol/L/year, respectively; P < 0.0001 for both). Median annual individual slopes were also significantly steeper in patients with MACE, and adjusted risk of MACE was 4.11 times higher (3.09-5.45) in patients with rapid decline in eGFR (change less than -5 mL/min/1.73 m(2)/year). Consideration of renal function trajectories provided significant additive information helping to explain the occurrence of MACE for both SCr and eGFR (PIDI < 0.0001 and P = 0.0005, respectively). These results were confirmed in the replication cohort. CONCLUSIONS: Renal function decline was associated with a higher risk of MACE. The pattern of renal function decline, beyond baseline kidney function, is an independent factor of CV risk.
OBJECTIVE: The pattern of renal function decline prior to cardiovascular (CV) events in type 2 diabetes is not well known. Our aim was to describe the association between renal function trajectories and the occurrence of a CV event. RESEARCH DESIGN AND METHODS: We considered patients with type 2 diabetes from the SURDIAGENE (Survie, Diabete de type 2 et Genetique) study (discovery cohort) and the DIABHYCAR (Non-Insulin-Dependent Diabetes, Hypertension, Microalbuminuria or Proteinuria, Cardiovascular Events, and Ramipril) study (replication cohort). Global patterns of estimated glomerular filtration rate (eGFR) (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]) and serum creatinine (SCr) prior to a major CV event (MACE) or last update were determined using a linear mixed-effects model and annual individual slopes computed by simple linear regression. RESULTS: In the 1,040 participants of the discovery cohort, establishment of global patterns including 22,227 SCr over 6.3 years of follow-up showed an annual eGFR decline and an annual SCr increase that were significantly greater in patients with MACE compared with patients without (-3.0 and -1.7 mL/min/1.73 m(2)/year and +10.7 and +4.0 μmol/L/year, respectively; P < 0.0001 for both). Median annual individual slopes were also significantly steeper in patients with MACE, and adjusted risk of MACE was 4.11 times higher (3.09-5.45) in patients with rapid decline in eGFR (change less than -5 mL/min/1.73 m(2)/year). Consideration of renal function trajectories provided significant additive information helping to explain the occurrence of MACE for both SCr and eGFR (PIDI < 0.0001 and P = 0.0005, respectively). These results were confirmed in the replication cohort. CONCLUSIONS: Renal function decline was associated with a higher risk of MACE. The pattern of renal function decline, beyond baseline kidney function, is an independent factor of CV risk.
Authors: Megumi Oshima; Min Jun; Toshiaki Ohkuma; Tadashi Toyama; Takashi Wada; Mark E Cooper; Samy Hadjadj; Pavel Hamet; Stephen Harrap; Giuseppe Mancia; Michel Marre; Bryan Williams; John Chalmers; Mark Woodward; Vlado Perkovic Journal: Diabetologia Date: 2019-07-13 Impact factor: 10.122
Authors: Shih-Chieh Shao; Yi-Han Lin; Kai-Cheng Chang; Yuk-Ying Chan; Ming-Jui Hung; Yea-Huei Kao Yang; Edward Chia-Cheng Lai Journal: BMJ Open Diabetes Res Care Date: 2019-12