In T2D, albuminuria regression signals longer survival

  • Anyanwagu U & al.
  • Am J Nephrol
  • 24 Jan 2019

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • In patients with type 2 diabetes (T2D), albuminuria is both a risk marker for renal and cardiovascular disease and an independent therapeutic target.

Why this matters

  • Albuminuria is associated with adverse renal and cardiovascular outcomes in patients with T2D.

Study design

  • Data analyzed for 11,074 new insulin users with T2D and baseline urinary albumin-to-creatinine ratio (ACR) ≥300 mg/g (albuminuria) from general UK practices, 2007-2014.
  • Of those, albuminuria regressed (ACR
  • Funding: Medical Research Council, Arthritis Research UK.

Key results

  • 5-year survival was:
    • 95% for patients with regression, vs 
    • 91% with persistent albuminuria;
    • 61 vs 621 deaths, respectively (P<.001>
  • Mortality rate adjusted for change in HbA1c and mean arterial pressure was 31% lower in regression vs persistent albuminuria groups:
    • adjusted [a]HR, 0.69 (P=.008).  
  • Risk for cardiovascular events (nonfatal myocardial infarction, stroke) was 27% lower in regression group:
    • aHR, 0.73 (P=.041).
  • Risk for composite major adverse cardiovascular events (all-cause mortality or nonfatal myocardial infarction or stroke) was 27% lower in regression group:
    • aHR, 0.737 (P=.002).

Limitations

  • Possible residual confounding.
  • Effect of competing hazards may bias risk estimates.
  • Changes in medications after baseline not evaluated.

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