Individual and Combined Relationship between Reduced eGFR and/or Increased Urinary Albumin Excretion Rate with...

Area of Science:

• Nephrology
• Cardiology
• Endocrinology
• Public Health

Background:

• Low estimated glomerular filtration rate (eGFR) and increased urinary albumin-to-creatinine ratio (ACR) are established markers of cardiovascular (CV) risk.
• The combined impact of eGFR and ACR on CV disease and mortality in insulin-treated type 2 diabetes (T2D) patients in routine care remains unclear.

Purpose of the Study:

• To investigate the association between chronic kidney disease markers (eGFR and ACR) and mortality rates in insulin-treated T2D patients.
• To determine the individual and combined prognostic value of eGFR and ACR for predicting mortality in this patient population.

Main Methods:

• Analysis of data from 18,227 insulin-treated T2D patients in UK general practices (2007-2014).
• Categorization of chronic kidney disease based on eGFR (<60 vs. ≥60 mL/min/1.73 m²) and ACR (<300 vs. ≥300 mg/g) at insulin initiation.
• Cox proportional hazard models were used to examine mortality rates after a 5-year follow-up period, adjusting for confounders.

Main Results:

• Patients with low eGFR (<60) and high ACR (≥300) faced the greatest risk of premature death.
• Reduced eGFR with normal ACR (<300) was associated with a 6% lower mortality rate compared to low eGFR + high ACR.
• Normal eGFR (≥60) with low ACR (<300) demonstrated the lowest mortality risk (28% lower), while high eGFR + high ACR showed a 20% reduction.

Conclusions:

• In insulin-treated T2D patients, the combination of reduced eGFR and increased ACR signifies the highest risk of premature death.
• Patients with reduced eGFR and normal ACR also face elevated mortality risks, underscoring the importance of kidney function monitoring.
• Aggressive cardiovascular risk management is crucial for high-risk T2D patients, particularly those with low eGFR and albuminuria, to reduce mortality.