Association of albuminuria and reduced estimated glomerular filtration rate with incident stroke and coronary artery disease in patients with type 2 diabetes

Abstract

It is unclear whether albuminuria and reduced glomerular filtration rate (GFR) independently increase the risk of incident stroke and coronary artery disease (CAD) in Japanese patients with diabetes. We investigated the independent effects of albuminuria and estimated GFR (eGFR) on the first occurrence of stroke and CAD in patients with type 2 diabetes mellitus (T2DM). We studied 1002 T2DM patients with eGFR (ml min À1 per 1.73 m 2 ) X15 and had no previous cardiovascular disease (CVD) history. GFR was estimated using the modified three-variable equation for the Japanese. Patients were divided into four eGFR categories: X90, 60-89, 30-59 and 15-29. The end point was an incident stroke and CAD events. The Cox proportional hazard model was used to calculate hazard ratio and 95% confidence interval. During a mean follow-up period of 5.2±2.1 years, 72 episodes of stroke and 90 of CAD were observed. Multivariate Cox analysis revealed no significant association between the eGFR category and incident stroke. The stroke hazard ratio (95% confidence interval) in reference to patients with an eGFR X90 was 0.78 (0.40-1.56) for patients with an eGFR of 60-89, 1.47 (0.70-3.10) for patients with an eGFR of 30-59 and 1.14 (0.39-3.35) for patients with an eGFR of 15-29. Reduced eGFR was a significant risk factor for CAD, with hazard ratios (95% confidence interval) for patients with an eGFRs of 60-89, 30-59 and 15-29 at 1.81 (1.01-3.57), 2.03 (1.04-4.40) and 3.01 (1.13-8.02), respectively. Reduced eGFR is independently associated with incident CAD but not stroke in Japanese patients with T2DM.

Microalbuminuria

“…We confirmed in our cohort the association of MA with the general cerebrovascular risk factors such as diabetes, atrial fibrillation, glucose level upon admission, age and chronic kidney disease reported in previous studies [13,14]. Interestingly, we found a significant association between MA and CRP levels.…”

A Trial of Pitavastatin Versus Rosuvastatin for Dyslipidemia in Chronic Kidney Disease

“…Recent evidence shows that, even before progression to end stage kidney disease (ESKD) requiring hemodialysis or renal transplantation, mild renal impairment and microalbuminuria are independent risk factors for atherosclerotic cardiovascular disease (CVD), such as myocardial infarction and stroke 1) . CKD is a disease concept advocated to encourage the early detection of kidney disease to avoid the development of CVD and progression to ESKD among the constantly increasing numbers of patients with longterm kidney damage.…”

Coronary Artery Disease Severity Assessment Using Urinary Dipstick Albumin Test

“…It was observed that the number of vessels involved was associated with an incremental increase in the amount of albumin excreted and this was statistically significant. Previous studies had concluded that the clinical outcomes were poorer in the albuminuric group as compared to the non albuminuric counterparts 7,8,9 , however, none of the studies demonstrated the relationship between the amount of albuminuria and the severity of obstruction of coronary arteries despite the fact that they used albumin creatinine ratio in the place urine spot albumin assay 10 . In acute coronary syndrome patients, if the other causes for albuminuria can be excluded, urinary dipstick albumin may be a useful tool to assess the likely severity of obstruction of coronary artery occlusion.…”