T2D: elevated urinary ACR and reduced eGFR tied to all-cause mortality

  • Anyanwagu U & al.
  • Kidney Dis (Basel)
  • 1 Mar 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In insulin-treated patients with type 2 diabetes (T2D), a combination of elevated albumin-to-creatinine ratio (ACR) levels and reduced estimated glomerular filtration rate (eGFR) is independently associated with an increased risk for all-cause mortality.

Why this matters

  • Findings may provide useful information to identify and prognosticate high-risk patients with T2D who are on insulin therapy to receive an additional cardiovascular (CV) risk management strategy.

Study design

  • 18,227 insulin-treated patients with T2D were categorised into 4 treatment groups:
    • Group 1 (low eGFR [2] + high ACR [≥300 mg/g]). 
    • Group 2 (low eGFR [2] + low ACR [
    • Group 3 (high eGFR [≥60 mLs/min/1.73 m2] + high ACR [≥300 mg/g]).
    • Group 4 (high eGFR [≥60 mLs/min/1.73 m2] + low ACR [
  • Primary endpoint: all-cause mortality.
  • Secondary endpoints: risks for CV events (non-fatal stroke and myocardial infarction [MI]) and 3-point composite major adverse CV events (MACEs; all-cause mortality, non-fatal MI and stroke).
  • Funding: None disclosed.

Key results

  • After a follow-up of 5 years, compared with Group 1, risk for all-cause mortality was lower in:
    • Group 2 (adjusted HR [aHR], 0.94; P=.515).
    • Group 3 (aHR, 0.80; P=.013).
    • Group 4 (aHR, 0.72; P=.001).
  • Compared with Group 1, risk for CV events was lower in:
    • Group 2 (aHR, 0.93; P=.486).
    • Groups 3 (aHR, 0.60) and 4 (aHR, 0.54; for both P<.001>
  • Compared with Group 1, risk for composite MACEs was lower in:
    • Group 2 (aHR, 0.93; P=.319).
    • Group 3 (aHR, 0.82; P=.002).
    • Group 4 (aHR, 0.73; P<.001>

Limitations

  • Retrospective design.

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