Giuseppe Penno1, Anna Solini2, Enzo Bonora3, Emanuela Orsi4, Cecilia Fondelli5, Gianpaolo Zerbini6, Roberto Trevisan7, Monica Vedovato8, Franco Cavalot9, Luigi Laviola10, Antonio Nicolucci11, Giuseppe Pugliese12. 1. Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. 2. Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy. 3. Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Verona, Italy. 4. Diabetes Unit, IRCCS "Cà Granda - Ospedale Maggiore Policlinico" Foundation, Milan, Italy. 5. Diabetes Unit, University of Siena, Siena, Italy. 6. Complications of Diabetes Unit, Division of Metabolic and Cardiovascular Sciences, San Raffaele Scientific Institute, Milan, Italy. 7. Endocrinology and Diabetes Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy. 8. Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy. 9. Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, Italy. 10. Department of Emergency and Transplants - Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy. 11. Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy. 12. Department of Clinical and Molecular Medicine, "La Sapienza" University, Via di Grottarossa, 1035-1039, 00189, Rome, Italy. giuseppe.pugliese@uniroma1.it.
Abstract
AIMS: To define the contribution of chronic kidney disease (CKD) to excess mortality in patients with type 2 diabetes and identify the baseline variables associated with all-cause death in those with and without CKD using the RECursive Partitioning and Amalgamation (RECPAM) method. METHODS: This observational, longitudinal, cohort study enrolled 15,773 consecutive non-dialytic patients with type 2 diabetes in 19 Diabetes Clinics throughout Italy in 2006-2008. Based on the presence of albuminuria ≥ 30 mg day-1 and/or estimated glomerular filtration rate (eGFR) < 60 mL min-1·1.73 m-2 at baseline, patients were classified as having or not CKD. Vital status was verified on October 31, 2015 for 99.26% of patients. RESULTS: Mortality increased with increasing albuminuria and eGFR category. Excess risk versus the general population was maximal in patients aged < 55 years in the worse albuminuria or eGFR category. Conversely, in subjects aged ≥ 75 years with albuminuria < 10 mg day-1 or eGFR ≥ 75 mL min-1·1.73 m-2, excess mortality was no longer detectable. At RECPAM analysis, the main correlates of death in the whole cohort were albuminuria > 44 mg day-1, prevalent CVD, and eGFR < ~ 75 mL min-1·1.73 m-2; gender, prevalent CVD, and higher albuminuria in the normoalbuminuric range, in patients without CKD; and CVD, eGFR ~ < 50 mL min-1·1.73 m-2, and albuminuria > 53 mg day-1, in those with CKD. CONCLUSIONS: CKD is a major contributor to excess mortality in type 2 diabetes, conferring a very high risk in younger patients and fully accounting for excess risk in the older ones. Higher albuminuria and lower eGFR, even in the normal range, identify individuals with increased mortality risk. Trial registration ClinicalTrials.gov (NCT00715481; https://clinicaltrials.gov/ct2/show/NCT00715481 ).
AIMS: To define the contribution of chronic kidney disease (CKD) to excess mortality in patients with type 2 diabetes and identify the baseline variables associated with all-cause death in those with and without CKD using the RECursive Partitioning and Amalgamation (RECPAM) method. METHODS: This observational, longitudinal, cohort study enrolled 15,773 consecutive non-dialytic patients with type 2 diabetes in 19 Diabetes Clinics throughout Italy in 2006-2008. Based on the presence of albuminuria ≥ 30 mg day-1 and/or estimated glomerular filtration rate (eGFR) < 60 mL min-1·1.73 m-2 at baseline, patients were classified as having or not CKD. Vital status was verified on October 31, 2015 for 99.26% of patients. RESULTS: Mortality increased with increasing albuminuria and eGFR category. Excess risk versus the general population was maximal in patients aged < 55 years in the worse albuminuria or eGFR category. Conversely, in subjects aged ≥ 75 years with albuminuria < 10 mg day-1 or eGFR ≥ 75 mL min-1·1.73 m-2, excess mortality was no longer detectable. At RECPAM analysis, the main correlates of death in the whole cohort were albuminuria > 44 mg day-1, prevalent CVD, and eGFR < ~ 75 mL min-1·1.73 m-2; gender, prevalent CVD, and higher albuminuria in the normoalbuminuric range, in patients without CKD; and CVD, eGFR ~ < 50 mL min-1·1.73 m-2, and albuminuria > 53 mg day-1, in those with CKD. CONCLUSIONS: CKD is a major contributor to excess mortality in type 2 diabetes, conferring a very high risk in younger patients and fully accounting for excess risk in the older ones. Higher albuminuria and lower eGFR, even in the normal range, identify individuals with increased mortality risk. Trial registration ClinicalTrials.gov (NCT00715481; https://clinicaltrials.gov/ct2/show/NCT00715481 ).
Authors: Rosilene Motta Elias; Maria Aparecida Dalboni; Ana Carolina E Coelho; Rosa M A Moysés Journal: Curr Osteoporos Rep Date: 2018-12 Impact factor: 5.096
Authors: Giuseppe Penno; Emanuela Orsi; Anna Solini; Enzo Bonora; Cecilia Fondelli; Roberto Trevisan; Monica Vedovato; Franco Cavalot; Gabriella Gruden; Luigi Laviola; Antonio Nicolucci; Giuseppe Pugliese Journal: BMJ Open Diabetes Res Care Date: 2020-07
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Authors: Aslam Amod; John B Buse; Darren K McGuire; Thomas R Pieber; Rodica Pop-Busui; Richard E Pratley; Bernard Zinman; Marco Bo Hansen; Ting Jia; Thomas Mark; Neil R Poulter Journal: Diabetes Ther Date: 2019-10-30 Impact factor: 2.945