Abstract 14145: The Impact of Mild and Moderate Chronic Kidney Disease at Baseline on Outcomes in Patients With Type 2 Diabetes Mellitus
Background: End-stage renal disease is associated with significantly increased cardiovascular morbidity and mortality; however the effects of mild and moderate (Stages I-III) chronic kidney disease (CKD) on cardiovascular morbidity and mortality have not been adequately studied in prospective randomized trials. We therefore evaluated the impact of mild and moderate CKD on health outcomes in all Action to Control Cardiovascular Risk in Diabetes (ACCORD) participants.
Methods: Baseline data on renal function were available in 10,136 (98.9%) high-risk type 2 diabetic patients of the original ACCORD participants. Of those, 6,506 (64.2%) were free of CKD at baseline, while 1,449 (14.3%) had Stage 1 CKD, 1,366 (13.5%) Stage 2 CKD, and 821 (8%) Stage 3 CKD, according to current guideline criteria. The primary outcome was a composite of nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death, while prespecified secondary outcomes included all-cause and cardiovascular mortality.
Results: The rate for the primary composite outcome was 87% (hazard ratio (HR): 1.87; 95% CI: 1.65-2.11; p<0.0001) higher in CKD compared to non-CKD patients. Patients with CKD had 62% higher risks for non-fatal myocardial infarction (HR 1.62; 95% CI: 1.38-1.90;p<0.0001), 149% higher risk for non-fatal stroke (HR: 2.49; CI: 1.835-3.378), 141% higher risk for any stroke (HR 2.41;CI 1.81- 3.22;p<0.0001)
56% higher risk for major coronary artery disease events (HR 1.56, CI 1.39,1.74;p<0.0001) and 219% increased risk for fatal or non-fatal congestive heart failure (HR 3.19; CI:2.62-3.89;p<0.0001) (219%). All-cause and cardiovascular mortality rates were increased by 97% (hazard ratio: 1.97; 95% CI: 1.70-2.29; p<0.0001) and 119% (hazard ratio: 2.199; 95% CI: 1.76-2.73; p<0.0001) in CKD compared to non-CKD patients.
Conclusions: When compared to non-CKD patients,patients with CKD were about twice as likely to have a cardiovascular event or die. Therefore, the recognition of mild and moderate CKD in patients with type 2 diabetes mellitus identifies a high-risk patient population that requires special attention.
- © 2013 by American Heart Association, Inc.