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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
Title | 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 |
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Authors | |
Keywords | Diabetes mellitus Estimated glomerular filtration rate (eGFR) Urine albumin-to-creatinine ratio (UACR) Cardiovascular diseases Mortality Primary care |
Issue Date | 2017 |
Publisher | BioMed 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? |
Abstract | Background:
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 Identifier | http://hdl.handle.net/10722/239559 |
ISSN | 2023 Impact Factor: 2.2 2023 SCImago Journal Rankings: 0.697 |
PubMed Central ID | |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Fung, SCC | - |
dc.contributor.author | Wan, YF | - |
dc.contributor.author | Chan, KC | - |
dc.contributor.author | Lam, CLK | - |
dc.date.accessioned | 2017-03-21T09:15:49Z | - |
dc.date.available | 2017-03-21T09:15:49Z | - |
dc.date.issued | 2017 | - |
dc.identifier.citation | BMC Nephrology, 2017, v. 18, article no. 47, p. 1-15 | - |
dc.identifier.issn | 1471-2369 | - |
dc.identifier.uri | http://hdl.handle.net/10722/239559 | - |
dc.description.abstract | Background: 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.language | eng | - |
dc.publisher | BioMed Central Ltd. The Journal's web site is located at http://www.biomedcentral.com/bmcnephrol/ | - |
dc.relation.ispartof | BMC Nephrology | - |
dc.rights | BMC Nephrology. Copyright © BioMed Central Ltd. | - |
dc.rights | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. | - |
dc.subject | Diabetes mellitus | - |
dc.subject | Estimated glomerular filtration rate (eGFR) | - |
dc.subject | Urine albumin-to-creatinine ratio (UACR) | - |
dc.subject | Cardiovascular diseases | - |
dc.subject | Mortality | - |
dc.subject | Primary care | - |
dc.title | 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 | - |
dc.type | Article | - |
dc.identifier.email | Fung, SCC: cfsc@hku.hk | - |
dc.identifier.email | Wan, YF: yfwan@hku.hk | - |
dc.identifier.email | Chan, KC: kcchanae@hku.hk | - |
dc.identifier.email | Lam, CLK: clklam@hku.hk | - |
dc.identifier.authority | Fung, SCC=rp01330 | - |
dc.identifier.authority | Wan, YF=rp02518 | - |
dc.identifier.authority | Lam, CLK=rp00350 | - |
dc.description.nature | published_or_final_version | - |
dc.identifier.doi | 10.1186/s12882-017-0468-y | - |
dc.identifier.pmid | 28152985 | - |
dc.identifier.pmcid | PMC5290675 | - |
dc.identifier.scopus | eid_2-s2.0-85011303935 | - |
dc.identifier.hkuros | 271539 | - |
dc.identifier.volume | 18 | - |
dc.identifier.spage | article no. 47, p. 1 | - |
dc.identifier.epage | article no. 47, p. 15 | - |
dc.identifier.isi | WOS:000397679900001 | - |
dc.publisher.place | United Kingdom | - |
dc.identifier.issnl | 1471-2369 | - |