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Article: Association of estimated glomerular filtration rate and urine albumin-to-creatinine ratio with incidence of cardiovascular diseases and mortality in chinese patients with type 2 diabetes mellitus – a population-based retrospective cohort study

TitleAssociation of estimated glomerular filtration rate and urine albumin-to-creatinine ratio with incidence of cardiovascular diseases and mortality in chinese patients with type 2 diabetes mellitus – a population-based retrospective cohort study
Authors
KeywordsDiabetes mellitus
Estimated glomerular filtration rate (eGFR)
Urine albumin-to-creatinine ratio (UACR)
Cardiovascular diseases
Mortality
Primary care
Issue Date2017
PublisherBioMed Central Ltd. The Journal's web site is located at http://www.biomedcentral.com/bmcnephrol/
Citation
BMC Nephrology, 2017, v. 18, article no. 47, p. 1-15 How to Cite?
AbstractBackground: Estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) are renal markers associated with risks of cardiovascular diseases (CVD) and all-cause mortality in diabetic patients. This study aims to quantify such risks in Chinese diabetic patients based on eGFR and UACR. Methods: This was a territory-wide retrospective cohort study on primary care diabetic patients with documented eGFR and UACR but without baseline CVD in 2008/2009. They were followed up till 2013 on CVD events and mortality. Associations between eGFR/UACR and incidence of CVD/mortality were evaluated by multivariable Cox proportional models adjusted with socio-demographic and clinical characteristics. Results: The data of 66,311 patients who had valid baseline eGFR and UACR values were analysed. The risks of CVD events and mortality increased exponentially with the decrease in eGFR, with a hazard ratio (HR) increasing from 1.63 to 4.55 for CVD, and from 1.70 to 9.49 for mortality, associated with Stage 3 to 5 CKD, compared to Stage 1 CKD. UACR showed a positive linear association with CVD events and mortality. Microalbuminuria was associated with a HR of 1.58 and 2.08 for CVD and mortality in male (1.48 and 1.79 for female), respectively, compared to no microalbuminuria. Male patients with UACR 1–1.4 mg/mmol and eGFR ≥90 ml/min/1.73 m2 (60–89 ml/min/1.73 m2) had a HR of 1.25 (1.43) for CVD. Female patients with UACR 2.5–3.4 mg/ml and eGFR ≥90 ml/min/1.73 m2 (60–89 ml/min/1.73 m2) had a HR of 1.45 (1.65) for CVD. Conclusions: Risks of CVD events and mortality increased exponentially with eGFR drop, while UACR showed positive predictive linear relationships, and the risks started even in high-normal albuminuria. UACR-based HR was further modified according to eGFR level, with risk progressed with CKD stage. Combining eGFR and UACR level was more accurate in predicting risk of CVD/mortality. The findings call for more aggressive screening and intervention of microalbuminuria in diabetic patients.
Persistent Identifierhttp://hdl.handle.net/10722/239559
ISSN
2017 Impact Factor: 2.395
2015 SCImago Journal Rankings: 1.113
PubMed Central ID
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorFung, SCC-
dc.contributor.authorWan, YF-
dc.contributor.authorChan, KC-
dc.contributor.authorLam, CLK-
dc.date.accessioned2017-03-21T09:15:49Z-
dc.date.available2017-03-21T09:15:49Z-
dc.date.issued2017-
dc.identifier.citationBMC Nephrology, 2017, v. 18, article no. 47, p. 1-15-
dc.identifier.issn1471-2369-
dc.identifier.urihttp://hdl.handle.net/10722/239559-
dc.description.abstractBackground: Estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) are renal markers associated with risks of cardiovascular diseases (CVD) and all-cause mortality in diabetic patients. This study aims to quantify such risks in Chinese diabetic patients based on eGFR and UACR. Methods: This was a territory-wide retrospective cohort study on primary care diabetic patients with documented eGFR and UACR but without baseline CVD in 2008/2009. They were followed up till 2013 on CVD events and mortality. Associations between eGFR/UACR and incidence of CVD/mortality were evaluated by multivariable Cox proportional models adjusted with socio-demographic and clinical characteristics. Results: The data of 66,311 patients who had valid baseline eGFR and UACR values were analysed. The risks of CVD events and mortality increased exponentially with the decrease in eGFR, with a hazard ratio (HR) increasing from 1.63 to 4.55 for CVD, and from 1.70 to 9.49 for mortality, associated with Stage 3 to 5 CKD, compared to Stage 1 CKD. UACR showed a positive linear association with CVD events and mortality. Microalbuminuria was associated with a HR of 1.58 and 2.08 for CVD and mortality in male (1.48 and 1.79 for female), respectively, compared to no microalbuminuria. Male patients with UACR 1–1.4 mg/mmol and eGFR ≥90 ml/min/1.73 m2 (60–89 ml/min/1.73 m2) had a HR of 1.25 (1.43) for CVD. Female patients with UACR 2.5–3.4 mg/ml and eGFR ≥90 ml/min/1.73 m2 (60–89 ml/min/1.73 m2) had a HR of 1.45 (1.65) for CVD. Conclusions: Risks of CVD events and mortality increased exponentially with eGFR drop, while UACR showed positive predictive linear relationships, and the risks started even in high-normal albuminuria. UACR-based HR was further modified according to eGFR level, with risk progressed with CKD stage. Combining eGFR and UACR level was more accurate in predicting risk of CVD/mortality. The findings call for more aggressive screening and intervention of microalbuminuria in diabetic patients.-
dc.languageeng-
dc.publisherBioMed Central Ltd. The Journal's web site is located at http://www.biomedcentral.com/bmcnephrol/-
dc.relation.ispartofBMC Nephrology-
dc.rightsBMC Nephrology. Copyright © BioMed Central Ltd.-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectDiabetes mellitus-
dc.subjectEstimated glomerular filtration rate (eGFR)-
dc.subjectUrine albumin-to-creatinine ratio (UACR)-
dc.subjectCardiovascular diseases-
dc.subjectMortality-
dc.subjectPrimary care-
dc.titleAssociation of estimated glomerular filtration rate and urine albumin-to-creatinine ratio with incidence of cardiovascular diseases and mortality in chinese patients with type 2 diabetes mellitus – a population-based retrospective cohort study-
dc.typeArticle-
dc.identifier.emailFung, SCC: cfsc@hku.hk-
dc.identifier.emailWan, YF: yfwan@hku.hk-
dc.identifier.emailChan, KC: kcchanae@hku.hk-
dc.identifier.emailLam, CLK: clklam@hku.hk-
dc.identifier.authorityFung, SCC=rp01330-
dc.identifier.authorityWan, YF=rp02518-
dc.identifier.authorityLam, CLK=rp00350-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1186/s12882-017-0468-y-
dc.identifier.pmid28152985-
dc.identifier.pmcidPMC5290675-
dc.identifier.scopuseid_2-s2.0-85011303935-
dc.identifier.hkuros271539-
dc.identifier.volume18-
dc.identifier.spagearticle no. 47, p. 1-
dc.identifier.epagearticle no. 47, p. 15-
dc.identifier.isiWOS:000397679900001-
dc.publisher.placeUnited Kingdom-

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