A novel kidney disease index reflecting both the albumin-to-creatinine ratio and estimated glomerular filtration rate, predicted cardiovascular and kidney outcomes in type 2 diabetes
Abstract Background The estimated glomerular filtration rate (eGFR) and the albumin-to-creatinine ratio (ACR) are risk factors for diabetes-related outcomes. A composite that captures information from both may provide a simpler way of assessing risk. Methods 9115 of 9901 Researching Cardiovascular E...
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-08-01
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| Series: | Cardiovascular Diabetology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12933-022-01594-6 |
| _version_ | 1811188839667990528 |
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| author | Hertzel C. Gerstein Chinthanie Ramasundarahettige Alvero Avezum Jan Basile Ignacio Conget William C. Cushman Gilles R. Dagenais Edward Franek Mark Lakshmanan Fernando Lanas Lawrence A. Leiter Nana Pogosova Jeffrey Probstfield Peter J. Raubenheimer Matthew Riddle Jonathan Shaw Wayne H.-H. Sheu Theodora Temelkova-Kurktschiev Ibrahim Turfanda Denis Xavier |
| author_facet | Hertzel C. Gerstein Chinthanie Ramasundarahettige Alvero Avezum Jan Basile Ignacio Conget William C. Cushman Gilles R. Dagenais Edward Franek Mark Lakshmanan Fernando Lanas Lawrence A. Leiter Nana Pogosova Jeffrey Probstfield Peter J. Raubenheimer Matthew Riddle Jonathan Shaw Wayne H.-H. Sheu Theodora Temelkova-Kurktschiev Ibrahim Turfanda Denis Xavier |
| author_sort | Hertzel C. Gerstein |
| collection | DOAJ |
| description | Abstract Background The estimated glomerular filtration rate (eGFR) and the albumin-to-creatinine ratio (ACR) are risk factors for diabetes-related outcomes. A composite that captures information from both may provide a simpler way of assessing risk. Methods 9115 of 9901 Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) participants with both an ACR and eGFR at baseline were included in this post hoc epidemiologic analysis. The hazard of higher baseline levels of 1/eGFR and natural log transformed ACR (calculated as ln [ACR × 100] to eliminate negative values) and their interaction for incident major adverse cardiovascular events (MACE), kidney outcomes, and deaths was estimated. The hazard of the geometric mean of these two baseline measures (the kidney disease index or KDI) was also assessed. Results A non-linear relationship was observed between 1/eGFR and all three outcomes, and between ln [ACR × 100] and the kidney outcome. There was also a negative interaction between these two risk factors with respect to MACE and death. Conversely, a linear relationship was noted between the KDI and all three outcomes. People in the highest KDI fifth experienced the highest incidence of MACE, death, and the kidney outcome (4.43, 4.56, and 5.55/100 person-years respectively). C statistics for the KDI were similar to those for eGFR and albuminuria. Conclusions The KDI combines the baseline eGFR and ACR into a novel composite risk factor that has a simple linear relationship with incident serious outcomes in people with diabetes and additional CV risk factors. Trial Registration clinicaltrials.gov NCT01394952. |
| first_indexed | 2024-04-11T14:26:00Z |
| format | Article |
| id | doaj.art-d7e83d72a5384fcfbe6664e1096dbb38 |
| institution | Directory Open Access Journal |
| issn | 1475-2840 |
| language | English |
| last_indexed | 2024-04-11T14:26:00Z |
| publishDate | 2022-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj.art-d7e83d72a5384fcfbe6664e1096dbb382022-12-22T04:18:53ZengBMCCardiovascular Diabetology1475-28402022-08-012111810.1186/s12933-022-01594-6A novel kidney disease index reflecting both the albumin-to-creatinine ratio and estimated glomerular filtration rate, predicted cardiovascular and kidney outcomes in type 2 diabetesHertzel C. Gerstein0Chinthanie Ramasundarahettige1Alvero Avezum2Jan Basile3Ignacio Conget4William C. Cushman5Gilles R. Dagenais6Edward Franek7Mark Lakshmanan8Fernando Lanas9Lawrence A. Leiter10Nana Pogosova11Jeffrey Probstfield12Peter J. Raubenheimer13Matthew Riddle14Jonathan Shaw15Wayne H.-H. Sheu16Theodora Temelkova-Kurktschiev17Ibrahim Turfanda18Denis Xavier19Population Health Research Institute, McMaster University and Hamilton Health SciencesPopulation Health Research Institute, McMaster University and Hamilton Health SciencesInternational Research Center, Hospital Alemao Oswaldo CruzMedical University of South CarolinaEndocrinology and Nutrition Department, University of BarcelonaDepartment of Preventive Medicine, University of Tennessee Health Science CenterInstitut Universitaire de Cardiologie et de Pneumologie de Québec, Université LavalMossakowski Clinical Research Center, Polish Academy of SciencesEli Lilly and CompanyUniversidad de La FronteraSt. Michael’s Hospital, Li Ka Shing Knowledge Institute, University of TorontoNational Medical Research Center of CardiologyUniversity of WashingtonDepartment of Medicine, University of Cape TownDepartment of Medicine, Oregon Health & Science University PortlandBaker Heart and Diabetes InstituteDivision of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Veterans General HospitalRobert Koch Medical CenterEli Lilly and Company, Lilly Corporate CenterSt. John’s Research Institute, St. John’s National Academy of Health SciencesAbstract Background The estimated glomerular filtration rate (eGFR) and the albumin-to-creatinine ratio (ACR) are risk factors for diabetes-related outcomes. A composite that captures information from both may provide a simpler way of assessing risk. Methods 9115 of 9901 Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) participants with both an ACR and eGFR at baseline were included in this post hoc epidemiologic analysis. The hazard of higher baseline levels of 1/eGFR and natural log transformed ACR (calculated as ln [ACR × 100] to eliminate negative values) and their interaction for incident major adverse cardiovascular events (MACE), kidney outcomes, and deaths was estimated. The hazard of the geometric mean of these two baseline measures (the kidney disease index or KDI) was also assessed. Results A non-linear relationship was observed between 1/eGFR and all three outcomes, and between ln [ACR × 100] and the kidney outcome. There was also a negative interaction between these two risk factors with respect to MACE and death. Conversely, a linear relationship was noted between the KDI and all three outcomes. People in the highest KDI fifth experienced the highest incidence of MACE, death, and the kidney outcome (4.43, 4.56, and 5.55/100 person-years respectively). C statistics for the KDI were similar to those for eGFR and albuminuria. Conclusions The KDI combines the baseline eGFR and ACR into a novel composite risk factor that has a simple linear relationship with incident serious outcomes in people with diabetes and additional CV risk factors. Trial Registration clinicaltrials.gov NCT01394952.https://doi.org/10.1186/s12933-022-01594-6Risk FactorKidneyAlbuminuriaCardiovascular OutcomesKidney Outcomes |
| spellingShingle | Hertzel C. Gerstein Chinthanie Ramasundarahettige Alvero Avezum Jan Basile Ignacio Conget William C. Cushman Gilles R. Dagenais Edward Franek Mark Lakshmanan Fernando Lanas Lawrence A. Leiter Nana Pogosova Jeffrey Probstfield Peter J. Raubenheimer Matthew Riddle Jonathan Shaw Wayne H.-H. Sheu Theodora Temelkova-Kurktschiev Ibrahim Turfanda Denis Xavier A novel kidney disease index reflecting both the albumin-to-creatinine ratio and estimated glomerular filtration rate, predicted cardiovascular and kidney outcomes in type 2 diabetes Cardiovascular Diabetology Risk Factor Kidney Albuminuria Cardiovascular Outcomes Kidney Outcomes |
| title | A novel kidney disease index reflecting both the albumin-to-creatinine ratio and estimated glomerular filtration rate, predicted cardiovascular and kidney outcomes in type 2 diabetes |
| title_full | A novel kidney disease index reflecting both the albumin-to-creatinine ratio and estimated glomerular filtration rate, predicted cardiovascular and kidney outcomes in type 2 diabetes |
| title_fullStr | A novel kidney disease index reflecting both the albumin-to-creatinine ratio and estimated glomerular filtration rate, predicted cardiovascular and kidney outcomes in type 2 diabetes |
| title_full_unstemmed | A novel kidney disease index reflecting both the albumin-to-creatinine ratio and estimated glomerular filtration rate, predicted cardiovascular and kidney outcomes in type 2 diabetes |
| title_short | A novel kidney disease index reflecting both the albumin-to-creatinine ratio and estimated glomerular filtration rate, predicted cardiovascular and kidney outcomes in type 2 diabetes |
| title_sort | novel kidney disease index reflecting both the albumin to creatinine ratio and estimated glomerular filtration rate predicted cardiovascular and kidney outcomes in type 2 diabetes |
| topic | Risk Factor Kidney Albuminuria Cardiovascular Outcomes Kidney Outcomes |
| url | https://doi.org/10.1186/s12933-022-01594-6 |
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