UACR, eGFR Predict Diabetics' Outcomes

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Albuminuria and renal function independently predict the risk of cardiovascular and renal events in patients with type 2 diabetes, data show.

The data emerged from a study of 10,640 patients with type 2 diabetes in which researchers examined the effects of urinary albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) on the risk of cardiovascular and renal events.

During an average 4.3 years of follow-up, 938 patients (8.8%) experienced a cardiovascular event (cardiovascular death, nonfatal MI, or nonfatal stroke) and 107 (1%) had a renal event (death as a result of renal disease, requirement for dialysis or transplantation, or doubling of serum creatinine to more than 200 μmol/L).

In adjusted analyses, investigators found that each 10-fold increment in baseline UACR—which they said corresponds approximately to a change from one clinical stage of albuminuria to the next (from normo- to microalbuminuria or from micro- to macroalbuminuria)—was associated with a 2.5, 3.9, and 10.5 times increased risk for any cardiovascular event, cardiovascular death, and renal events. Each halving of baseline eGFR was associated with a 2.2, 3.6, and 63.6 times increased risk of these outcomes, respectively.

Findings were published in the Journal of the American Society of Nephrology (2009;20:1813-1821).

The researchers, led by Vlado Perkovic, MD, of the George Institute for International Health at the University of Sydney in Australia, found no association between the effects of higher UACR and lower eGFR.

Patients with both a UACR greater than 300 mg/g and eGFR below 60 mL/min/1.73 m2 at baseline had a 3.2 times higher risk for cardiovascular events and a 22 times higher risk for renal events compared with patients who did not have either of these risk factors. 

“These analyses demonstrate that both increased urinary albumin excretion and reduced eGFR are independently and continuously associated with the risk for both cardiovascular and kidney outcomes in patients with type 2 diabetes,” the authors wrote.

“There was no evidence of any interaction between these risk factors, so patients with both elevated albuminuria and reduced eGFR were at the highest risk, and the relationship was not mitigated by adjustment for other conventional risk factors.”

The investigators added that their analyses “highlight the potential additional value of assessment of albuminuria and eGFR in the risk assessment for individuals with type 2 diabetes.”

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