Type 2 diabetes : identifying patients at risk for renal dysfunction

  • Zelniker TA & al.
  • Clin Chem
  • 15 Apr 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In patients with type 2 diabetes mellitus (T2DM) and a history of or at a higher risk for cardiovascular disease (CVD), higher levels of high-sensitivity cardiac troponin T (hs-TnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hs-CRP) are associated with subsequent worsening renal function and albuminuria.

Why this matters

  • Findings suggest evaluation of cardiac and inflammatory biomarkers may help in risk assessment for microvascular complications such as renal deterioration in addition to cardiovascular outcomes.

Study design

  • This exploratory analysis of SAVOR-TIMI 53 trial evaluated serum levels of hs-TnT, NT-proBNP and hs-CRP in 12,310 patients with T2DM across all quartiles (Q1-Q4).
  • Primary outcome: ≥40% decrease in estimated glomerular filtration rate (eGFR) at the end of treatment (EOT).
  • Other outcomes: worsening in urinary albumin-to-creatinine ratio (UACR) at EOT and the composite endpoint (dialysis, renal transplantation or a serum creatinine >6.0 mg/dL).
  • Funding: None disclosed.

Key results

  • Higher levels of hs-TnT (adjusted OR [aOR], 5.63), NT-proBNP (aOR, 3.53) and hs-CRP (aOR, 1.84; Ptrend<.001 for all were significantly associated with reduction in egfr at eot q4 vs q1 quartile.>
  • Elevated levels of hs-TnT (aOR, 2.72), NT-proBNP (aOR, 1.88) and hs-CRP (aOR, 1.31; Ptrend<.001 for all were significantly associated with a higher risk of worsening uacr in q4 vs q1 quartile.>
  • There was a significant association between hs-TnT (aOR, 4.40), NT-proBNP (aOR, 7.59) and hs-CRP (aOR, 1.66; Ptrend<.001 for all and composite endpoint in q4 vs q1 quartile.>
  • In an adjusted multi-marker model, hs-TnT (aOR, 1.62; 95% CI, 1.42-1.86) and NT-proBNP (aOR,1.50; 95% CI, 1.28-1.78) were significantly associated with ≥40% reduction in eGFR and all 3 biomarkers were associated with worsening of UACR (P<.01>

Limitations

  • Biomarkers, particularly troponin and natriuretic peptides, increased with declining renal function.
  • Relatively short duration of the trial in terms of renal outcomes.

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