Renal function trajectories predict CV events in diabetes patients

By Eleanor McDermid

Steeper declines in renal function over time are associated with greater increases in the risk of major cardiovascular events (MACE) among patients with Type 2 diabetes, research shows.

The researchers found that the estimated glomerular filtration rate (eGFR) declined at an annual average of 3.0 mL/min per 1.73 m² among 218 Type 2 diabetes patients who had a MACE over an average 6.3 years of follow-up in the SURDIAGENE study. The annual decline was significantly less steep, at 1.7 mL/min per 1.73 m², among 922 patients who remained free of MACE over the same time period.

After accounting for baseline variables, including eGFR, diabetes duration and medication use, patients with an annual decline greater than 5.0 mL/min per 1.73 m² had a significant 4.11-fold increased risk of MACE, compared with patients with more gradual declines in renal function. And this pattern was confirmed in a replication cohort of 2572 patients from the DIABHYCAR study.

Associations with MACE risk were also present for changes in serum creatinine levels, report Stéphanie Ragot (Université de Poitiers, France) and study co-authors.

Levels increased at a rate of 5.5 µmol/L per year among patients with MACE, compared with 1.0 µmol/L per year among patients without, and having an annual increase greater than 14.0 µmol/L increased the likelihood of MACE 3.15-fold.

Ragot et al believe serum creatinine to be worth measuring, being a direct rather than estimated measure, which is not influenced by increasing age during follow-up. They also note that the formula used to estimate GFR correlates more strongly with renal function at a single timepoint than over time, making serum creatinine "an interesting biomarker to evaluate follow-up changes".

"Consequently, not only eGFR trajectory but also [serum creatinine] trajectory should be considered as a means of capturing the dynamics of renal function modifications with regard to CV diseases", they write in Diabetes Care.

They say that such "simple and inexpensive" biomarkers will be helpful for "fine tuning the prognosis of patients with type 2 diabetes."

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