1. Joint relationship between renal function and proteinuria on mortality of patients with type 2 diabetes: the Taichung Diabetes Study
- Author
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Sing Yu Yang, Ching-Chu Chen, Pei Tseng Kung, Sharon L.R. Kardia, Tsai-Chung Li, Chiu-Shong Liu, Cheng-Chieh Lin, Cheng-Chun Lee, Chia Ing Li, and Wen-Yuan Lin
- Subjects
Male ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Time Factors ,Endocrinology, Diabetes and Metabolism ,Type 2 diabetes ,Kaplan-Meier Estimate ,urologic and male genital diseases ,Kidney ,Risk Factors ,Cause of Death ,Risk of mortality ,Diabetic Nephropathies ,Prospective Studies ,Registries ,Reagent Strips ,Original Investigation ,Proteinuria ,Mortality rate ,Hazard ratio ,Middle Aged ,Prognosis ,female genital diseases and pregnancy complications ,Cardiovascular Diseases ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Glomerular Filtration Rate ,Adult ,medicine.medical_specialty ,Urology ,Taiwan ,Renal function ,Urinalysis ,Risk Assessment ,Internal medicine ,Diabetes mellitus ,medicine ,Humans ,Mortality ,Aged ,Proportional Hazards Models ,business.industry ,medicine.disease ,Endocrinology ,Diabetes Mellitus, Type 2 ,lcsh:RC666-701 ,Concomitant ,Multivariate Analysis ,business - Abstract
Background Estimated glomerular filtration rate (eGFR) is a powerful predictor of mortality in diabetic patients with limited proteinuria data. In this study, we tested whether concomitant proteinuria increases the risk of mortality among patients with type 2 diabetes. Methods Participants included 6523 patients > 30 years with type 2 diabetes who were enrolled in a management program of a medical center before 2007. Renal function was assessed by eGFR according to the Modification of Diet in Renal Disease Study equation for Chinese. Proteinuria was assessed by urine dipstick. Results A total of 573 patients (8.8%) died over a median follow-up time of 4.91 years (ranging from 0.01 year to 6.42 years). The adjusted expanded cardiovascular disease (CVD)-related mortality rates among patients with proteinuria were more than three folds higher for those with an eGFR of 60 mL/min/1.73 m2 or less compared with those with an eGFR of 90 mL/min/1.73 m2 or greater [hazard ratio, HR, 3.15 (95% confidence interval, CI, 2.0–5.1)]. The magnitude of adjusted HR was smaller in patients without proteinuria [1.98 (95% CI, 1.1–3.7)]. An eGFR of 60 mL/min/1.73 m2 to 89 mL/min/1.73 m2 significantly affected all-cause mortality and mortality from expanded CVD-related causes only in patients with proteinuria. Similarly, proteinuria affected all outcomes only in patients with an eGFR of 2. Conclusion The risks of all-cause mortality, as well as expanded and non-expanded mortality from CVD-related causes associated with proteinuria or an eGFR of 90 mL/min/1.73 m2 or greater are independently increased. Therefore, the use of proteinuria measurements with eGFR increases the precision of risk stratification for mortality.
- Published
- 2012