CKD/Diabetes Outcomes Improved With Risk Factor Control
Multiple risk factor control (MRFC) could help to lower the elevated risk of mortality and cardiovascular events in individuals with diabetes and chronic kidney disease (CKD), according to the results of a recent study.
For their population-based cohort study, researchers assessed 11,431 patients with CKD (estimated glomerular filtration rate: eGFR 15–59 mL/min/1.73 m2) and 36,429 participants with non-CKD (eGFR ≥60 mL/min/1.73 m2). All participants were aged 40 to 79 years and had type 2 diabetes and valid serum creatinine measurements.
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MRFC was defined as hemoglobin A1c <53 mmol/mol (<7.0%), blood pressure <140/90 mm Hg, total cholesterol <5 mmol/L, and not smoking.
Overall, 37% and 13% of participants with CKD met 3 or 4 MRFC criteria, respectively. For those with CKD meeting 4 criteria, the adjusted hazard ratio (HR) for all-cause mortality was 0.60 and the adjusted subdistribution HR for cardiovascular was 0.60. Those meeting 4 criteria also had lower relative hazards for coronary heart disease (adjusted subdistribution HR 0.73) and stroke (adjusted subdistribution HR 0.63), considering a competing risk of non-cardiovascular death.
“In this population-based cohort study of participants with type 2 diabetes and CKD stages 3 or 4, MRFC was associated with lower relative risks for mortality and cardiovascular diseases. We also confirmed that CKD was associated with increased risks for mortality and cardiovascular events. Higher absolute risks for mortality and cardiovascular events and great relative risk reduction associated with MRFC suggest that the MRFC strategy may be one of the main approaches to potentially reducing the burden of diabetes and CKD,” the researchers concluded.
—Michael Potts
Reference:
Hamada S, Gulliford MC. Multiple risk factor control, mortality and cardiovascular events in type 2 diabetes and chronic kidney disease: a population-based cohort study [published online May 8, 2018]. BMJ Open. doi: 10.1136/bmjopen-2017-019950.