Multiple risk factor control may lower mortality risk in patients with T2DM and CKD

  • Hamada S & al.
  • BMJ Open
  • 8 May 2018

  • from Sarfaroj Khan
  • Clinical Summaries
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Takeaway

  • Multiple risk factor control (MRFC) may lower increased risks for mortality and cardiovascular events in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD).

Why this matters

  • Presence of diabetes and CKD substantially increase the economic burden as a result of high cost of cardiovascular therapy and dialysis treatments.
  • Associations of MRFC with lower risks for mortality and cardiovascular events have been shown in people with diabetes, not focusing on CKD status.

Study design

  • Population-based cohort study evaluated the effectiveness of MRFC on mortality and cardiovascular events in participants aged 40-79 years with T2DM including 11,431 CKD patients and 36,429 non-CKD patients.
  • MRFC included 4 components: HbA1c <53 mmol/mol (<7.0%), BP <140/90 mm Hg, total cholesterol <5 mmol/L, and no smoking.
  • Funding: None disclosed.

Key results

  • Mean estimated glomerular filtration rate level was 49 mL/min/1.73m2 in patients with CKD and 81 mL/min/1.73 m2 in the non-CKD group.
  • Among patients with CKD, 3 criteria of MRFC were met by 37% of patients and 4 criteria met by 13% of patients.
  • Higher number of risk factor control was found to be associated with decreased risk for all outcomes.
  • In patients with CKD meeting 4 criteria, reduced risk for all-cause mortality (adjusted HR [aHR], 0.60; 95% CI, 0.53-0.69), cardiovascular mortality (aHR, 0.60; 95% CI, 0.50-0.70), coronary heart disease (aHR, 0.73; 95% CI, 0.59-0.91) and stroke (aHR, 0.63; 95% CI, 0.45-0.89) was observed.

Limitations

  • Risk for bias.
  • Risk for confounding.