Cardiovascular risk due to diabetes mellitus in patients with chronic kidney disease—prospective data from the German Chronic Kidney Disease cohort

Author:

Ruhe Johannes1,Nadal Jennifer2,Bärthlein Barbara3,Meiselbach Heike4,Schultheiss Ulla T567,Kotsis Fruzsina567,Stockmann Helena8,Krane Vera9,Sommerer Claudia10,Löffler Ivonne1,Saritas Turgay11,Kielstein Jan T12,Sitter Thomas13,Schneider Markus P4,Schmid Matthias2,Wanner Christoph9,Eckardt Kai-Uwe48,Wolf Gunter1,Busch Martin1ORCID

Affiliation:

1. Department of Internal Medicine III, Nephrology, University Hospital Jena – Friedrich Schiller University , Jena , Germany

2. Department of Medical Biometry, Informatics, and Epidemiology, University Hospital Bonn , Bonn , Germany

3. Medical Centre for Information and Communication Technology, University Hospital Erlangen , Erlangen , Germany

4. Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg , Erlangen , Germany

5. Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg , Freiburg , Germany

6. Department , Freiburg , Germany

7. of Medicine IV-Nephrology and Primary Care, Faculty of Medicine and Medical Center, University of Freiburg , Freiburg , Germany

8. Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin , Berlin , Germany

9. Division of Nephrology, Department of Medicine I, University Hospital Würzburg , Würzburg , Germany

10. Nephrology Unit, University Hospital Heidelberg , Heidelberg , Germany

11. Division of Nephrology and Clinical Immunology, University Hospital RWTH Aachen , Aachen , Germany

12. Medical Clinic V Nephrology, Rheumatology, Blood Purification – Academic Teaching Hospital Braunschweig , Braunschweig , Germany

13. Department of Medicine, Ludwig-Maximilians-University Hospital Munich , Munich , Germany

Abstract

ABSTRACT Background Diabetes mellitus (DM) and chronic kidney disease (CKD) are well-known cardiovascular and mortality risk factors. To what extent they act in an additive manner and whether 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/1.73 m2 and/or proteinuria >0.5 g/day. We categorized patients whose CKD was 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 [hazard ratio (HR) 1.92; 95% confidence interval (CI) 1.59–2.32] and cardiovascular (HR 2.25; 95% CI 1.62–3.12) deaths, 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 extent 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) only increased 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 to HHF.

Funder

BMBF

KfH Foundation for Preventive Medicine

Publisher

Oxford University Press (OUP)

Subject

Transplantation,Nephrology

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