Abstract P435: Kidney Function and the Risk of Diabetic Complications among Louisiana Low Income Diabetic Patients
Background: Coronary heart disease (CHD), heart failure (HF), stroke, and lower extremity amputation (LEA) are major diabetic complications. Although the association of kidney function with the risks of diabetic complications has been studied among apparently healthy people, no study has addressed the race-specific association of kidney function with the risks of these diabetic complications among diabetic patients. Aim: To investigate the race-specific association of kidney function measured by glomerular filtration rate (GFR) and plasma creatinine with the risks of CHD, HF, stroke and LEA within the Louisiana State University (LSU) Hospital System.
Methods: We performed a prospective cohort study (1999-2010) on diabetic patients enrolled in the LSU Hospital-Based Longitudinal Study. The cohort included 5,955 non-Hispanic White men, 8,757 non-Hispanic White women, 6,592 African American men and 12,250 African American women who were 30 to 90 years of age and who had a mean family income of $12,716/year at baseline. Cox proportional hazards regression models were used to estimate the association of GFR and plasma creatinine categories with the risks of CHD, HF, stroke and LEA after adjustment for age, sex, smoking, income, type of insurance, body mass index, systolic blood pressure, diabetes type, glycosylated hemoglobin, low-density lipoprotein cholesterol, triglycerides, use of antihypertensive drugs, use of diabetes medications, and use of cholesterol-lowering agents.
Results: During a mean follow up of 6.0 years for CHD, 6.3 years for HF, 6.6 years for stroke, and 6.9 years for LEA, 7,477 CHD, 6,105 HF, 3,584 stroke, and 571 LEA incident cases were identified. Age- and sex-adjusted hazard ratios of CHD associated with the GFR categories (≥90, 60-89, 30-59, and 15-29 mL/min/1.73 m2) were 1.00, 1.09 (95% confidence interval [CI] 1.02-1.18), 1.45 (95% CI 1.31-1.61), and 2.06 (95% CI 1.61-2.64) (P trend<0.001) for African American diabetic patients, and 1.00, 1.09 (95% CI 1.01-1.17), 1.32 (95% CI 1.20-1.46), and 2.05 (95% CI 1.59-2.64) (P trend<0.001) for White diabetic patients, respectively. A significantly increased risk of HF, stroke and LEA was observed among both African American and White participants with GFR<60 mL/min/1.73 m2. A positive association of plasma creatinine concentrations with the risks of HF, stroke and LEA was observed among both African American and White diabetic patients.
Conclusions: The current study suggests that impaired kidney function (i.e., GFR<60 mL/min/1.73m2) is associated with an increased risk of CHD, HF, stroke and LEA in low income diabetic patients.
- © 2013 by American Heart Association, Inc.