Cardiovascular outcome according to renal status in Finnish patients with type 2 diabetes

Abstract

Background: Type 2 diabetes (T2DM) increases the risk for chronic kidney disease (CKD). The objective of this study was to describe the characteristics of patients with T2DM and assess their cardiovascular (CV) and renal outcomes as well as survival in a real-life setting in Finland. The study aimed to map the use of diagnostic and monitoring measures in the management of T2DM patients in clinical practice and to assess the proportion of patients that could benefit from SGLT2 inhibitor treatment. Methods: This retrospective registry study included 29,628 adult T2DM patients gathered from national registries in Finland between 2012 and 2018. Patients were included from primary and specialized care. From all patients, all available health care data, including laboratory results, degree of albuminuria, and eGFR data, was gathered. The occurrence of CV events and end-stage kidney disease (ESKD) was assessed using a multivariable Cox proportional hazards model. All-cause and CV deaths were visualized using Kaplan-Meier plots. Results: Overall, patients were more frequently male (54%), and their mean age was 66 (SD = ±12.4) years. eGFR status was available for 21,889 patients, and among these patients CKD stage 3–5 was observed in 3,945 (13.3%) patients. Data on albuminuria was available in less than half (45.5%) of the cohort. In patients with available urinary albumin measurement, increased albumin excretion was present in 12% of patients with CKD class 1–2, of whom 1.6% had severe albuminuria. Of all comorbidities, atrial fibrillation was independently associated with the risk of CV events and ESKD. Conclusions: This large real-world study confirms that CV morbidity and mortality are substantial within T2DM patients, and that age, prior kidney function, albuminuria and prior diagnosis of AF were associated with the risk of CV events, including death, and progression to ESKD. Despite guideline recommendations, monitoring and treatment of T2DM was suboptimal leaving patients at risk of inadequate treatment.