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Defining the contribution of chronic kidney disease to all-cause mortality in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study.
Acta Diabetol. 2018 Jun; 55(6):603-612.AD

Abstract

AIMS

To define the contribution of chronic kidney disease (CKD) to excess mortality in patients with type 2 diabetes and identify the baseline variables associated with all-cause death in those with and without CKD using the RECursive Partitioning and Amalgamation (RECPAM) method.

METHODS

This observational, longitudinal, cohort study enrolled 15,773 consecutive non-dialytic patients with type 2 diabetes in 19 Diabetes Clinics throughout Italy in 2006-2008. Based on the presence of albuminuria ≥ 30 mg day-1 and/or estimated glomerular filtration rate (eGFR) < 60 mL min-1·1.73 m-2 at baseline, patients were classified as having or not CKD. Vital status was verified on October 31, 2015 for 99.26% of patients.

RESULTS

Mortality increased with increasing albuminuria and eGFR category. Excess risk versus the general population was maximal in patients aged < 55 years in the worse albuminuria or eGFR category. Conversely, in subjects aged ≥ 75 years with albuminuria < 10 mg day-1 or eGFR ≥ 75 mL min-1·1.73 m-2, excess mortality was no longer detectable. At RECPAM analysis, the main correlates of death in the whole cohort were albuminuria > 44 mg day-1, prevalent CVD, and eGFR < ~ 75 mL min-1·1.73 m-2; gender, prevalent CVD, and higher albuminuria in the normoalbuminuric range, in patients without CKD; and CVD, eGFR ~ < 50 mL min-1·1.73 m-2, and albuminuria > 53 mg day-1, in those with CKD.

CONCLUSIONS

CKD is a major contributor to excess mortality in type 2 diabetes, conferring a very high risk in younger patients and fully accounting for excess risk in the older ones. Higher albuminuria and lower eGFR, even in the normal range, identify individuals with increased mortality risk. Trial registration ClinicalTrials.gov (NCT00715481; https://clinicaltrials.gov/ct2/show/NCT00715481).

Authors+Show Affiliations

Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy.Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Verona, Italy.Diabetes Unit, IRCCS "Cà Granda - Ospedale Maggiore Policlinico" Foundation, Milan, Italy.Diabetes Unit, University of Siena, Siena, Italy.Complications of Diabetes Unit, Division of Metabolic and Cardiovascular Sciences, San Raffaele Scientific Institute, Milan, Italy.Endocrinology and Diabetes Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy.Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, Italy.Department of Emergency and Transplants - Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy.Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy.Department of Clinical and Molecular Medicine, "La Sapienza" University, Via di Grottarossa, 1035-1039, 00189, Rome, Italy. giuseppe.pugliese@uniroma1.it.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

29574497

Citation

Penno, Giuseppe, et al. "Defining the Contribution of Chronic Kidney Disease to All-cause Mortality in Patients With Type 2 Diabetes: the Renal Insufficiency and Cardiovascular Events (RIACE) Italian Multicenter Study." Acta Diabetologica, vol. 55, no. 6, 2018, pp. 603-612.
Penno G, Solini A, Bonora E, et al. Defining the contribution of chronic kidney disease to all-cause mortality in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study. Acta Diabetol. 2018;55(6):603-612.
Penno, G., Solini, A., Bonora, E., Orsi, E., Fondelli, C., Zerbini, G., Trevisan, R., Vedovato, M., Cavalot, F., Laviola, L., Nicolucci, A., & Pugliese, G. (2018). Defining the contribution of chronic kidney disease to all-cause mortality in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study. Acta Diabetologica, 55(6), 603-612. https://doi.org/10.1007/s00592-018-1133-z
Penno G, et al. Defining the Contribution of Chronic Kidney Disease to All-cause Mortality in Patients With Type 2 Diabetes: the Renal Insufficiency and Cardiovascular Events (RIACE) Italian Multicenter Study. Acta Diabetol. 2018;55(6):603-612. PubMed PMID: 29574497.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Defining the contribution of chronic kidney disease to all-cause mortality in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study. AU - Penno,Giuseppe, AU - Solini,Anna, AU - Bonora,Enzo, AU - Orsi,Emanuela, AU - Fondelli,Cecilia, AU - Zerbini,Gianpaolo, AU - Trevisan,Roberto, AU - Vedovato,Monica, AU - Cavalot,Franco, AU - Laviola,Luigi, AU - Nicolucci,Antonio, AU - Pugliese,Giuseppe, AU - ,, Y1 - 2018/03/24/ PY - 2018/01/24/received PY - 2018/03/17/accepted PY - 2018/3/27/pubmed PY - 2018/7/18/medline PY - 2018/3/26/entrez KW - Albuminuria KW - All-cause mortality KW - Cardiovascular risk factors KW - Chronic kidney disease KW - Glomerular filtration rate KW - Type 2 diabetes SP - 603 EP - 612 JF - Acta diabetologica JO - Acta Diabetol VL - 55 IS - 6 N2 - AIMS: To define the contribution of chronic kidney disease (CKD) to excess mortality in patients with type 2 diabetes and identify the baseline variables associated with all-cause death in those with and without CKD using the RECursive Partitioning and Amalgamation (RECPAM) method. METHODS: This observational, longitudinal, cohort study enrolled 15,773 consecutive non-dialytic patients with type 2 diabetes in 19 Diabetes Clinics throughout Italy in 2006-2008. Based on the presence of albuminuria ≥ 30 mg day-1 and/or estimated glomerular filtration rate (eGFR) < 60 mL min-1·1.73 m-2 at baseline, patients were classified as having or not CKD. Vital status was verified on October 31, 2015 for 99.26% of patients. RESULTS: Mortality increased with increasing albuminuria and eGFR category. Excess risk versus the general population was maximal in patients aged < 55 years in the worse albuminuria or eGFR category. Conversely, in subjects aged ≥ 75 years with albuminuria < 10 mg day-1 or eGFR ≥ 75 mL min-1·1.73 m-2, excess mortality was no longer detectable. At RECPAM analysis, the main correlates of death in the whole cohort were albuminuria > 44 mg day-1, prevalent CVD, and eGFR < ~ 75 mL min-1·1.73 m-2; gender, prevalent CVD, and higher albuminuria in the normoalbuminuric range, in patients without CKD; and CVD, eGFR ~ < 50 mL min-1·1.73 m-2, and albuminuria > 53 mg day-1, in those with CKD. CONCLUSIONS: CKD is a major contributor to excess mortality in type 2 diabetes, conferring a very high risk in younger patients and fully accounting for excess risk in the older ones. Higher albuminuria and lower eGFR, even in the normal range, identify individuals with increased mortality risk. Trial registration ClinicalTrials.gov (NCT00715481; https://clinicaltrials.gov/ct2/show/NCT00715481). SN - 1432-5233 UR - https://www.unboundmedicine.com/medline/citation/29574497/Defining_the_contribution_of_chronic_kidney_disease_to_all_cause_mortality_in_patients_with_type_2_diabetes:_the_Renal_Insufficiency_And_Cardiovascular_Events__RIACE__Italian_Multicenter_Study_ L2 - https://dx.doi.org/10.1007/s00592-018-1133-z DB - PRIME DP - Unbound Medicine ER -