Cardiovascular events and mortality in chronic kidney disease in primary care patients with previous type 2 diabetes and/or hypertension. A population-based epidemiological study (KIDNEES)

Abstract

Background Chronic Kidney Disease (CKD), Type 2 Diabetes (T2D) and Hypertension (HTN) are frequently associated with adverse outcomes. We aimed to estimate the impact of a prior diagnosis of T2D and/or HTN on clinical characteristics, cardiovascular events (CVE) and all-cause mortality (ACM) of patients with CKD. Methods We conducted a retrospective cohort study based on primary care electronic health records of people without atherosclerotic cardiovascular disease, aged 18–90 years with incident CKD between January 1, 2007, and December 31, 2017. The association between CKD groups classified according to prior diagnosis of T2D and/or HTN and risk of ACM and CVE at follow-up was evaluated with Cox and Fine-Gray regression models, respectively. Results 398,477 patients were included. Median age was 74 years and 55.2% were women. Individuals were classified as CKD with HTN (51.9%), CKD with T2D (3.87%), CKD with HTN/T2D (31.4%) and CKD without HTN/T2D (12.9%). In the multivariate analysis, with the CKD without HTN/T2D group as reference, the ACM Hazard Ratio (HR) was 0.74 (95%CI 0.72–0.75) for the CKD with HTN group, 0.81 (95%CI 0.79–0.83) for CKD with HTN/T2D and 1.14 (95%CI 1.10–1.19) for the CKD with T2D group. The sub distribution HRs for CVE were 1.40 (95%CI 1.34–1.47), 1.70 (95%CI 1.61–1.80) and 1.37 (95%CI 1.26–1.48), respectively. Conclusion In patients with CKD, the risk of ACM and CVE differed in patients with previous HTN and/or T2D. These comorbidities can help identify individuals at higher risk of adverse outcomes and improve the management of patients with CKD in primary care.

Characteristics of patients with chronic kidney disease and Type 2 diabetes initiating finerenone in the USA: a multi-database, cross-sectional study

“…In our study, mean age was 68–72, years, median eGFR 44 ml/min/1.73 m 2 , and median UACR 110–339 mg/g. Previous studies performed in European populations of patients with CKD and T2D have shown a similar clinical profile to that observed in our study [ 27 , 28 ]. In the FIDELITY pooled analysis, which combined data from the FIGARO and FIDELIO trials, mean age was 64.8 years, 30.2% of patients were female, baseline eGFR was 57.6 ml/min/1.73 m 2 , and baseline UACR 515 mg/g [ 10 ].…”

“…Compared with the overall population, patients taking concomitant SGLT2i had lower eGFR and UACR. This proportion of ACEi and ARB use is similar to that observed in prior observational studies of patients with CKD and T2D [ 28–30 ]. In FIDELITY, almost all patients were receiving RAS inhibitors, 7% SGLT2i and GLP-1RA, and the CV and renal benefits of finerenone were independent of treatment with SGLT2i and GLP-1RA [ 10 , 31 ].…”