257-OR: Diabetic Kidney Disease (DKD) and Nonalcoholic Fatty Liver Disease (NAFLD) Confer Worsening All-Cause Mortality and Cardiovascular Disease (CVD) Risk in Type 2 Diabetes (T2D)

Abstract

Aim: In T2D, the prevalence of NAFLD is 56-60% and approximately 40% have DKD; thus, a sizable proportion of subjects may have both conditions. We explored to which extent the coexistence of the two could further worsen mortality and CVD risk in T2D. Methods: We recorded vital status and data for major CVD (the latter available for 98.5% subjects) were retrieved on December 31st, 2017. DKD (eGFR <60 ml/min/1.73 m2 and/or ACR ≥30 mg/g) and NAFLD (fatty liver index ≥60) effects assessed by Kaplan-Meier curves and hazard ratios (HR, 95% CI) by adjusted Cox regressions. Results: Distributions of NAFLD and DKD are reported in Table. HbA1c was similar in subgroups; NAFLD had worse metabolic and inflammatory profile, DKD higher hypertension rate. Over a follow-up of 13.1±2.8 years, we recorded 229 deaths (23.8%) and 273 major CV (28.8%). Rates of other outcomes are reported in Table. Death rate was 16.3, 21.8, 25.6 and 43.8% (p<0.0001) across groups with full adjusted HR (Model 2), of 1.50 (1.07-2.10, p=0.020) in NAFLD only, 1.15 (0.58-2.27, p=0.697) in DKD only, and 2.73 (1.90-3.93, p<0.0001) in DKD/NAFLD. Table reports effects of DKD-NAFLD combinations on CV outcomes. Conclusions: DKD and NAFLD concur increasing mortality and CVD risk in T2D patients. Monitoring and managing DKD and NAFLD is required to prevent CVD and reduce mortality. Disclosure M.Garofolo: Consultant; Novo Nordisk, Employee; Eli Lilly and Company. D.Lucchesi: None. M.Giambalvo: None. M.Capobianco: None. P.Francesconi: None. G.Penno: Advisory Panel; Eli Lilly and Company, Bayer Inc., Consultant; Novo Nordisk, AstraZeneca, Boehringer Ingelheim Inc. S.Del prato: Advisory Panel; Abbott Diagnostics, Altimmune, Amarin Corporation, Applied Therapeutics Inc., Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk A/S, Vertex Pharmaceuticals Incorporated, Novartis, Consultant; A. Menarini Diagnostics, Research Support; AstraZeneca, Boehringer Ingelheim International GmbH, Speaker's Bureau; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk A/S, Sanofi.