Prior CV Events Increase Risk for ESRD in Type 2 Diabetes Patients
Intercurrent cardiovascular (CV) events, particularly heart failure (HF), are significantly associated with the risk for end-stage renal disease (ESRD) in patients with type 2 diabetes, according to a recent study.
It is currently unclear whether CV events affect the progression to ESRD among type 2 diabetes patients.
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For their study, the researchers assessed 4022 patients with type 2 diabetes, anemia, and chronic kidney disease (CKD) who were enrolled in the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT).
ESRD was defined as the initiation of dialysis for more than 30 days, kidney transplantation, or refusal or nonavailability of renal replacement therapy. Study outcomes included ESRD and post-ESRD mortality within 30 days and throughout follow-up after an intercurrent CV event.
Ultimately, the researchers found that the incidence of ESRD within 30 days was higher in patients with an intercurrent CV event vs those without an intercurrent CV event.
Results indicated that 155 (23.8%) of 652 ESRD cases had followed an intercurrent CV event. Furthermore, the relative risks for ESRD had been higher following HF within 30 days and overall, compared with myocardial infarction or stroke. Specifically, 110 (16.9%) cases had occurred after HF, 28 (4.3%) had occurred after myocardial infarction, 12 (1.84%) had occurred after stroke, and 5 (0.77%) had occurred after multiple CV events.
Patients with ESRD after intercurrent CV events were older, more likely to have prior CV disease, had higher baseline eGFRs (24.4 mL/min/1.73 m2 vs 23.1 mL/min/1.73 m2) and higher eGFRs at their last measurement before ESRD (18.6 mL/min/1.73 m2 vs 15.2 mL/min/1.73 m2), compared with those without pre-ESRD events. However, race, sex, and medication use were similar in all patients, and post-ESRD mortality was similar in patients with and without prior CV events.
“Most ESRD cases occurred in individuals without intercurrent CV events who had lower eGFRs than individuals with intercurrent CV events, but similar post-ESRD mortality,” the researchers concluded. “Nevertheless, intercurrent CV events, particularly heart failure, are strongly associated with risk for ESRD. These findings underscore the need for kidney-specific therapies in addition to treatment of CV risk factors to lower ESRD incidence in diabetes.”
—Christina Vogt
Reference:
Charytan DM, Solomon SD, Ivanovich P, et al. ESRD after heart failure, myocardial infarction, or stroke in type 2 diabetic patients with CKD. Am J Kidney Dis. 2017;70(4):522-531. http://dx.doi.org/10.1053/j.ajkd.2017.04.018.