Serum Creatinine Doubling Ups Cardiovascular Risks in Diabetes Patients

Patients with serum creatinine doubling had increased risks of heart failure, myocardial infarction, and stroke.
Patients with serum creatinine doubling had increased risks of heart failure, myocardial infarction, and stroke.

Doubling of serum creatinine is associated with an increased risk of cardiovascular (CV) events in patients with chronic kidney disease (CKD) and type 2 diabetes, according to a new study.

Using the Clinical Practice Research Datalink, a UK database of some 8 million individuals enrolled with general practitioners, a team led by Christoph R. Meier, PhD, of University Hospital Basel in Basel, Switzerland, identified 27,811 adult patients with CKD and type 2 diabetes. Of these, 21,215 had a follow-up of time of at least 3 years. Doubling of serum creatinine occurred in 1,262 patients.

Angina pectoria, congestive heart failure (CHF), myocardial infarction (MI), stroke, and transient ischemic attack developed in 693, 1069, 508, 970, and 578 patients, respectively. Compared with patients who did not have a doubling of serum creatinine, those who did had a nearly 3 times increased risk of CHF, 2.5 times increased risk of MI, and 1.9 times increased risk of stroke, the investigators reported in Clinical Epidemiology (2016;8177-184). The groups with and without a doubling of serum creatinine had similar risks of angina pectoris and transient ischemic attack.

The researchers also looked at CV risk estimates by sex, and found the most pronounced sex disparity for MI. Among patients who had a doubling of serum creatinine, women had a 3.32 times increased risk of MI compared with a 1.84 times increased risk for men compared with patients who did not have a doubling of serum creatinine.

Dr Meier's group noted that their results are based on data from the primary care setting, and acknowledged “there is a possibility that we may have missed some cases with cardiovascular outcomes, particularly milder forms of the outcomes of interest. However, as most cardiovascular outcomes in this study represent acute and rather severe diseases, we are confident that few cases with an outcome of interest have been missed.”

For the study, the investigators considered patients to have CKD if they had at least 2 estimated glomerular filtration rate values below 90 mL/min/1.73 m2, separated by at least 90, but not more than 730 days. Most patients (56.4% and 71.8% in the groups with and without doubling of serum creatinine, respectively) had an eGFR of 75 to 89 mL/min/1.73 m2 at or prior to baseline.

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