LEADER-6: Baseline renal function and associated factors in a high cardiovascular risk type 2 diabetes population

To examine the prevalence of chronic kidney disease (CKD) and its associated factors in a multinational population with type 2 diabetes mellitus (T2DM) and prior cardiovascular disease (CVD).

The LEADER trial randomized 9340 participants-81.3% with prior CVD at baseline. CKD was defined as estimated GFR <60ml/min/1.73m² and/or an albumin-to-creatinine ratio ≥3.0mg/mmol.

At baseline, 51.9% of participants with prior CVD had CKD. CKD prevalence was highest in Asia (75.8%) and lowest in Europe (43.7%) and the Middle East (43.4%). Baseline factors associated with increased CKD prevalence included increased age, HbA_1c, diabetes duration, systolic blood pressure or triglyceride levels; greater number of antihypertensive medications; living in Asia, the Americas or Africa versus Europe; being male; and not receiving oral antidiabetic drugs (most receiving insulin), beta-blockers or ACE inhibitors. Factors associated with decreased CKD prevalence included increased diastolic blood pressure, no diuretic treatment and prior myocardial infarction, angina or stroke.

CKD prevalence is high among patients with T2DM and prior CVD. Advanced age, long diabetes duration, poor glycemic control, comorbidities and medications used are associated with CKD. Our results strengthen the rationale for early screening and interventions for CKD in patients with T2DM and prior CVD.