Cardiovascular risk due to diabetes mellitus in patients with chronic kidney disease - Prospective data from the German Chronic Kidney Disease cohort
Johannes Ruhe, Jennifer Nadal, Barbara Bärthlein, Heike Meiselbach, Ulla T Schultheiss, Fruzsina Kotsis, Helena Stockmann, Vera Krane, Claudia Sommerer, Ivonne Löffler, Turgay Saritas, Jan T Kielstein, Thomas Sitter, Markus P Schneider, Matthias Schmid, Christoph Wanner, Kai-Uwe Eckardt, Gunter Wolf, Martin Busch- Transplantation
- Nephrology
Abstract
Background
Diabetes mellitus (DM) and chronic kidney disease (CKD) are well-known cardiovascular and mortality risk factors. To which extent they act additive and if the etiology of CKD modifies the risk is uncertain.
Methods
The multicenter, prospective, observational German Chronic Kidney Disease study comprises 5217 participants (1868 with DM) with a baseline mean estimated glomerular filtration rate of 30–60 mL/min/1.73m2 and/or proteinuria > 0.5 g/day. We categorized patients whose CKD is caused by cardiovascular or metabolic diseases (CKDcvm) with and without DM as opposed to genuine CKD (CKDgen) with and without DM. Recorded outcomes were first events of non-cardiovascular and cardiovascular death, 4-point major adverse cardiovascular events (4-point MACE) and hospitalization for heart failure (HHF).
Results
During the 6.5-year follow-up 603 (12%) non-cardiovascular and 209 (4%) cardiovascular deaths, 645 (12%) 4-point MACE, and 398 (8%) HHF were observed, most frequently in patients with DM having CKDcvm. DM increased the risk of non-cardiovascular (HR 1.92; 95%CI 1.59–2.32) and cardiovascular deaths (HR 2.25; 95%CI 1.62–3.12), 4-point MACE (HR 1.93; 95%CI 1.62–2.31) and HHF (HR 1.87; 95%CI 1.48–2.36). Mortality risks were elevated by DM to a similar extend in CKDcvm and CKDgen, but for HHF in CKDcvm only (HR 2.07; 95%CI 1.55–2.77). In patients with DM, CKDcvm (versus CKDgen) increased only the risk for HHF (HR 1.93; 95%CI 1.15–3.22).
Conclusions
DM contributes to cardiovascular and mortality excess risk in patients with moderate to severe CKD in both, CKDcvm and CKDgen. Patients with DM and CKDcvm are particularly susceptible for HHF.