AER Is a More Sensitive Predictive Factor than eGFR for CVD in Patients with Type 2 Diabetes—Results from a Perspective Study in Beijing Communities

Abstract

Objective: The predictive values of AER and eGFR for CVD outcomes in T2DM patients have not been well documented. In this study, the effects of AER and eGFR on outcomes of CVD were analyzed in a population of T2DM patients. Methods: 1914 T2DM patients were enrolled in this 8 -year prospective study in Beijing Communities. The patients’ serum creatinine levels were lower than 176.8μmol/l. The risk of CVD onset was assessed according to CKD staging, which was categorized by urine albumin excretion (AER; mg/d) and estimated GFR (eGFR; ml min −11.73 m−2). The effects of AER and eGFR on risk of cardiovascular disease onset in type 2 diabetes after eight years’ prevention were also analyzed. Results: The mean age and BMI of patients were 66.4 ± 10.1 years and 25.5 ± 3.5 kg/m2, respectively; the duration of diabetes was 5.7 to 17.8 years. The proportion of patients with hypertension and smokers were 71.11% and 16.84%. During the follow-up period (median 6.8 years), 71 CVD events occurred. At baseline, those with AER≥300 mg/d and co-existing eGFR 60-89 ml min −11.73 m−2 or <60 ml min −1/1.73 m−2 showed increased risk for CVD onset when compared with ’no CKD’. No increased risk was observed for patients with AER <30 mg/d and eGFR <60 ml min −11.73 m−2. The increased CVD risk was observed in patients progressed to AER ≥30mg/d during follow-up period, whereas patients who progressed to eGFR <90 ml min −11.73 m−2 alone showed no increased CVD risk. During the follow-up period, 8.7% patients with microalbuminuria (n=166) and 1.8% patients with overt nephropathy (n=34) reversed to normoalbuminuria or microalbuminuria. Conclusions: AER is a more sensitive predictor than eGFR for CVD onset in T2DM patients. DKD, even patients with overt nephropathy can be reversed after multi-factorial intervention in a part of patients. Disclosure X. Zhang: None. S. Yuan: None.