How are kidney disease and CVD linked in T2D?

  • Vaduganathan M & al.
  • Am J Cardiol
  • 6 Nov 2018

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Serum Cystatin C, but not urine-based renal biomarkers, predicts cardiovascular (CV) disease (CVD) risk in people with type 2 diabetes (T2D) following acute coronary syndrome (ACS).

Why this matters

  • Mechanisms underlying the link between chronic kidney disease and cardiovascular disease are unclear.  

Study design

  • Evaluation of prognostic performance of serum Cystatin C and urine renal biomarkers (neutrophil gelatinase-associated lipocalin, kidney injury molecule-1 protein, and urinary protein excretion indices) in 5380 patients with T2D and recent ACS in EXAMINE.
  • Primary endpoint was composite nonfatal myocardial infarction, nonfatal stroke, or CV death.
  • Funding: Takeda.

Key results

  • During 18-month median follow-up, primary endpoint, death, and heart failure hospitalization occurred in 11.5%, 6.1%, and 3.0%, respectively.
  • After adjustments including for baseline estimated glomerular filtration rate, all biomarkers were strongly associated with all endpoints.  
  • However, with all 5 renal biomarkers tested simultaneously in a multimarker integrative model, only Cystatin C (per 1 standard deviation) was associated with the primary endpoint (adjusted HR, 1.28; P≤.001) and all-cause mortality (adjusted HR, 1.51; P≤.001).
  • After full adjustment, Cystatin C remained the only renal biomarker associated with clinical events.

Limitations

  • Findings limited to EXAMINE criteria.
  • Missing protein excretion data.
  • Possible residual confounding.
  • No accounting for time-updated covariates.

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