Renal function and attributable risk of death and cardiovascular hospitalization in participants with diabetes from a registry-based cohort

Manuel Ruiz-Quintero; Josep Redón; María Téllez-Plaza; Ana M Cebrián-Cuenca; Jorge Navarro-Pérez; Edelmiro Menéndez; Ana Perez-Navarro; Antonio Fernández-Giménez; Adriana López-Pineda; José A Quesada; Vicente Pallares-Carratalá; Vicente F Gil-Guillen; José M Martin-Moreno; Jesús Bleda-Cano; Sara Carrascosa; Concepción Carratalá-Munuera

doi:10.1016/j.pcd.2020.06.004

Renal function and attributable risk of death and cardiovascular hospitalization in participants with diabetes from a registry-based cohort

Prim Care Diabetes. 2021 Feb;15(1):88-94. doi: 10.1016/j.pcd.2020.06.004. Epub 2020 Jul 6.

Authors

Manuel Ruiz-Quintero¹, Josep Redón², María Téllez-Plaza³, Ana M Cebrián-Cuenca⁴, Jorge Navarro-Pérez⁵, Edelmiro Menéndez⁶, Ana Perez-Navarro⁷, Antonio Fernández-Giménez⁸, Adriana López-Pineda⁹, José A Quesada¹⁰, Vicente Pallares-Carratalá¹¹, Vicente F Gil-Guillen¹², José M Martin-Moreno¹³, Jesús Bleda-Cano¹⁴, Sara Carrascosa¹⁵, Concepción Carratalá-Munuera¹⁶

Affiliations

¹ Agost Primary Health Care Center, Agost 03698, Alicante, Spain. Electronic address: [email protected].
² Department of Internal Medicine, Hospital Clinico de Valencia, University of Valencia, INCLIVA Research Institute, Valencia 46010, Spain; CIBERObn, ISCIII, Madrid, Spain. Electronic address: [email protected].
³ Institute for Biomedical Research. Hospital Clinic of Valencia, Valencia, Spain. Electronic address: [email protected].
⁴ San Anton Primary Health Center, Cartagena, 30205 Murcia, Spain. Electronic address: [email protected].
⁵ Valencia Clinic Hospital, Department of Medicine, University of Valencia, INCLIVA Research Institute, Valencia 46010, Spain. Electronic address: [email protected].
⁶ Endocrinology and Nutrition Department, Central de Asturias University Hospital, ENDO Group, Health Research Institut of Principado de Asturias (ISPA), Oviedo 33011, Spain. Electronic address: [email protected].
⁷ ESCARVAL Group Study CRO, CEO of Exilio SI SL, Valencia 46010, Spain. Electronic address: [email protected].
⁸ ESCARVAL Group Study CRO, CEO of Exilio SI SL, Valencia 46010, Spain. Electronic address: [email protected].
⁹ Miguel Hernandez University, Ctra. Nnal. 332 Alicante-Valencia s/n, 03550 San Juan de Alicante, Alicante, Spain. Electronic address: [email protected].
¹⁰ Miguel Hernandez University, Ctra. Nnal. 332 Alicante-Valencia s/n, 03550 San Juan de Alicante, Alicante, Spain. Electronic address: [email protected].
¹¹ Health Surveillance Department, Union de Mutuas, 12004 Castellon, Spain; Medicine Department, Jaume I University, 12071, Castellon, Spain. Electronic address: [email protected].
¹² Miguel Hernandez University, Ctra. Nnal. 332 Alicante-Valencia s/n, 03550 San Juan de Alicante, Alicante, Spain. Electronic address: [email protected].
¹³ Department of Preventive Medicine & INCLIVA, University of Valencia, Valencia 46010, Spain. Electronic address: [email protected].
¹⁴ Centro de salud integrado El Campello, El Campello 03560, Alicante, Spain. Electronic address: [email protected].
¹⁵ Consultorio Auxiliar Garbinet de Alicante, Alicante 03015, Spain. Electronic address: [email protected].
¹⁶ Miguel Hernandez University, Ctra. Nnal. 332 Alicante-Valencia s/n, 03550 San Juan de Alicante, Alicante, Spain. Electronic address: [email protected].

PMID: 32646765
DOI: 10.1016/j.pcd.2020.06.004

Abstract

Aims: To estimate the attributable risk of renal function on all-cause mortality and cardiovascular hospitalization in patients with diabetes.

Methods: A prospective cohort study in 19,469 adults with diabetes, free of cardiovascular disease, attending primary care in Spain (2008-2011). The estimated glomerular filtration rate (eGFR) and other variables were collected and patients were followed to the first hospitalization for coronary or stroke event, or death, until the end of 2012. The cumulative incidence of the study endpoints by eGFR categories was graphically displayed and adjusted population attributable risks (PARs) for low eGFR was calculated.

Results: Mean follow-up was 3.2 years and 506 deaths and 1720 hospitalizations were recorded. The cumulative risk for the individual events increased as eGFR levels decreased. The PAR associated with having an eGFR of 60mL/min/1.73m² or less was 11.4% (95% CI 4.8-18.3) for all-cause mortality, 9.2% (95% CI 5.3-13.4) for coronary heart disease, and 2.6% (95% CI -1.8 to 7.4) for stroke.

Conclusions: Reduced eGFR levels were associated with a larger proportion of avoidable deaths and cardiovascular hospitalizations in people with diabetes compared to previously reported results in people with other cardiovascular risk factors.

Keywords: Attributable risk; Cardiovascular diseases; Diabetes mellitus; Hypertension; Kidney dysfunction; Mortality.

MeSH terms

Adult
Cardiovascular Diseases* / diagnosis
Cardiovascular Diseases* / epidemiology
Cohort Studies
Diabetes Mellitus* / diagnosis
Diabetes Mellitus* / epidemiology
Glomerular Filtration Rate
Hospitalization
Humans
Kidney / physiology
Prospective Studies
Registries
Renal Insufficiency, Chronic* / diagnosis
Renal Insufficiency, Chronic* / therapy
Risk Factors