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Mild renal insufficiency as a cardiovascular risk factor in non-proteinuric type II diabetes

2003; Elsevier BV; Volume: 64; Issue: 3 Linguagem: Inglês

10.1016/j.diabres.2003.10.018

1872-8227

José Antonio Gimeno-Orna, Luis M. Lou-Arnal, Beatriz Boned-Juliani, Edmundo Molinero-Herguedas,

Diabetes Treatment and Management

Objectives: To evaluate cardiovascular risk according to baseline renal function in a group of non-proteinuric type II diabetic patients. Material and methods: Prospective study with a follow-up of 423 non-proteinuric type II diabetic patients with creatinine <150 μmol/l for an average of 4.7 years (S.D. 1.55). Creatinine clearance (CC) was estimated using the Cockcroft–Gault formula and expressed in millilitre per minute. The hazard ratio (HR) associated with each millilitre per minute decrease in baseline CC on fatal or non-fatal cardiovascular events and total mortality was evaluated using the Cox regression model. Results: Baseline creatinine was 89 μmol/l (S.D. 15.9) and CC was 69.5 ml/min (S.D. 20). There were 63 cardiovascular events (15 unstable angina, 10 non-fatal myocardial infarctions, 25 non-fatal strokes, two amputations, nine fatal myocardial infarctions and two fatal strokes) and 39 total deaths (11 for cardiovascular causes). The cardiovascular event rate was 31.7/1000 patient-years and the total mortality rate was 19.6/1000 patient-years. The independent predictors of cardiovascular events were: CC (HR=1.035; confidence interval (CI) 95% 1.02–1.05; P<0.0001), total cholesterol/HDL cholesterol ratio (HR=1.25; CI 95% 1.1–1.4; P=0.0008), baseline coronary heart disease (HR=2.05; CI 95% 1.07–3.9; P=0.04) and baseline microalbuminuria (HR=2.3; CI 95% 1.3–3.8; P=0.003). The independent total mortality predictors were: CC (HR=1.04; CI 95% 1.02–1.08; P<0.0001), male (HR=2.1; CI 95% 1.1–4;P=0.027) and baseline microalbuminuria (HR=2.1; CI 95% 1.1–4;P=0.03). Conclusions: Mild renal insufficiency increases cardiovascular risk in non-proteinuric patients with type II diabetes.