In patients with type 2 diabetes and nephropathy, a lower creatinine excretion rate (CER) is associated with higher all-cause mortality, according to research published online ahead of print in Diabetes Care.

To examine whether CER is associated with outcome in diabetes, Steef J. Sinkeler, MD, of the University of Groningen in the Netherlands, and colleagues used data from two trials involving 1,872 patients with type 2 diabetes and nephropathy and 24-hour urinary creatinine excretion data.

After a median follow-up period of 36 months, 300 patients had died. Factors positively and independently associated with CER were body surface area, hemoglobin, black race, and albuminuria, whereas female gender and age were inversely and independently associated with CER. The risk of all-cause mortality increased as CER decreased in a Kaplan-Meier analysis of sex-stratified tertiles of the CER.

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“In conclusion, the CER, which serves as a surrogate marker for muscle mass, was inversely associated with all-cause mortality in diabetic patients with nephropathy, thus indicating that the CER can be used as a risk marker in this population,” the authors write. “It would be of interest to see whether halting the loss of muscle mass seen in diabetes by physical activity may improve outcomes.”

The trials were sponsored by Merck, Bristol Myers Squibb, and Sanofi-Aventis. One author disclosed financial ties to Merck.

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