RT Journal Article
SR Electronic
T1 Acute Kidney Injury Predicts Major Adverse Outcomes in Diabetes: Synergic Impact With Low Glomerular Filtration Rate and Albuminuria
JF Diabetes Care
JO Diabetes Care
FD American Diabetes Association
SP dc151222
DO 10.2337/dc15-1222
A1 Monseu, Mathilde
A1 Gand, Elise
A1 Saulnier, Pierre-Jean
A1 Ragot, Stéphanie
A1 Piguel, Xavier
A1 Zaoui, Philippe
A1 Rigalleau, Vincent
A1 Marechaud, Richard
A1 Roussel, Ronan
A1 Hadjadj, Samy
A1 Halimi, Jean-Michel
A1 ,
YR 2015
UL http://care.diabetesjournals.org/content/early/2015/10/20/dc15-1222.abstract
AB OBJECTIVE Subjects with diabetes are prone to the development of cardiovascular and noncardiovascular complications. In separate studies, acute kidney injury (AKI), albuminuria, and low estimated glomerular filtration rate (eGFR) were shown to predict adverse outcomes, but, when considered together, their respective prognostic value is unknown.RESEARCH DESIGN AND METHODS Patients with type 2 diabetes consecutively recruited in the SURDIAGENE cohort were prospectively followed up for major diabetes-related events, as adjudicated by an independent committee: death (with cause), major cardiovascular events (myocardial infarction, stroke, congestive heart failure, amputation, and arterial revascularization), and renal failure (i.e., sustained doubling of serum creatinine level or end-stage renal disease).RESULTS Intrahospital AKI occurred in 411 of 1,371 patients during the median follow-up period of 69 months. In multivariate analyses, AKI was significantly associated with cardiovascular and noncardiovascular death, including cancer-related death. In multivariate analyses, AKI was a powerful predictor of major adverse cardiovascular events, heart failure requiring hospitalization, myocardial infarction, stroke, lower-limb amputation or revascularization, and carotid artery revascularization. AKI, eGFR, and albuminuria, even when simultaneously considered in multivariate models, predicted all-cause and cardiovascular deaths. All three renal biomarkers were also prognostic of most adverse outcomes and of the risk of renal failure.CONCLUSION AKI, low eGFR, and elevated albuminuria, separately or together, are compelling biomarkers of major adverse outcomes and death in diabetes.