Abstract 1246: Reduced Renal Function (EGFR) And Albuminuria In Type 2 Diabetes Independently Predict Cardiovascular (CVD) Events And Mortality Even In A Low Risk Cohort: The FIELD Study
Background: In the general population reduced estimated glomerular filtration rate (eGFR) using the MDRD model predicts increasing CVD morbidity and mortality. This has also been shown in some groups with type 2 diabetes. Similarly increasing baseline albuminuria in type 2 diabetes is associated with increased mortality in follow-up studies. We aimed to quantitate the relationship between early stages of chronic kidney disease (CKD) and albuminuria at baseline, and subsequent CVD outcomes.
Methods: We studied the 9795 patients in the FIELD double-blind randomised study of fenofibrate (200mg daily) or placebo, followed up for a median of 5 years. Mean age at entry was 62 years, 63% were male and mean duration of diabetes was 5 years. No patient at entry had CKD stage 4 or 5 (eGFR < 30 ml/min/1.73m2). CVD events and mortality were adjudicated by an independent committee using pre-defined criteria. We used the baseline eGFR (MDRD model for calculation) and the albumin:creatinine ratio (ACR) both based on two samples collected prior to randomization. ACR was classified using sex-specific criteria as normo-, micro- or macro-albuminuria.
Results: When baseline CKD stages 0 –1 with no albuminuria is defined as a hazard ratio of 1, increasing baseline renal impairment (CKD stages 2 and 3; p<0.0001) and increasing albuminuria (p<0.0001) independently predict all-cause and cardiovascular mortality as well as the total occurrence of CVD events (Table⇓). The overlap of worsening CKD stages and increasing proteinuria is not extensive.
Conclusion: Both increasing baseline stage of CKD (Stages 0 –1, 2 and 3) and rising albuminuria independently predict CVD events and mortality, and also all-cause mortality. The two risk factors identify substantially different populations.