Differential associations of eGFR and UACR with CVD subtypes in patients with diabetes

Kidney function measures and cardiovascular outcomes in people with diabetes: the Hoorn Diabetes Care System cohort

Presented at the EASD 2021 by: Elisa Dal Canto, MD - Amsterdam, The Netherlands

Introduction and methods

It has been well established that the kidney function measures eGFR and albuminuria independently predict CVD. In HFpEF, albuminuria and eGFR are differently associated with distinct cardiac phenotypes. This raised the question whether there are differential association between each manifestation of kidney disease in diabetes (atherosclerotic vs. non-atherosclerotic) and types of CVD. In addition, the impact of longitudinal changes of kidney function measures on CVD risk is not well understood.

In this study, data of the cohort of the Hoorn Diabetes Care System were used consisting of >14,000 patients with diabetes with information of annually collected measurements on CV risk factors, microvascular complications and CV events. 13,657 Patients with diabetes were included in this study. Median follow-up was 7 years.

Main results

• Risk for myocardial infarction was increased in patients with mildly reduced (60-90) and reduced (<59) eGFR compared to those with normal eGFR (>90) (HR 1.53, 95%CI:1.10-2.13, P=0.011 and HR 1.80, 95%CI: 1.15-2.81, P=0.010, respectively).
• Also, risk for coronary heart disease was increased in patients with mildly reduced and reduced eGFR (HR 1.68, 95%CI:1.24-2.28, P=0.001 and HR 2.05, 95%CI:1.37-3.08, P<0.001, respectively).
• In patients with mildly reduced and reduced eGFR, risk of stroke was increased compared to those with normal eGFR (HR 2.54, 95%CI: 1.28-5.05, P=0.008 and HR 2.51, 95%CI: 1.00-6.30, P=0.049, respectively).
• There was no association between reduced eGFR and risk of HF or CV mortality.
• In patients with mildly increased (UACR 3.0 -30.0 mg/mmol) and increased UACR (>30.0 mg/mmol), risk of CV mortality was increased (HR 1.98, 95%CI: 1.50-2.63, P<0.001 and HR 3.16, 95%CI: 2.03-4.92, P<0.001).
• There was an association between albuminuria and HF, but only in women (in those with UACR>3.0, HR was 2.78, 95%CI: 1.50-5.20, P=0.001) (P-interaction for sex was 0.01)).
• Increased UACR was associated with higher risk of MI and CHD, but only when UACR>30.0 mg/mmol.
• Increased UACR was not associated with higher risk of stroke.

Conclusion

In this study of diabetes patients in the Hoorn Diabetes Care System, longitudinal decrease of eGFR was associated with higher risk of MI, CHD and stroke. Moreover, longitudinal increase of UACR was associated with higher risk of CV mortality, higher risk of HF in women but not in men, and a higher risk of MI and CHD but only when UACR was >30 mg/mmol.

When discussing the findings of this study, Dal Canto raised some questions: Do eGFR and UACR play distinct role in CV pathophysiology? And what would be the incremental value of eGFR and UACR when added to CV risk score for the prediction of CV outcomes in patients with diabetes?

- Our reporting is based on the information provided at the EASD Virtual Meeting–