Abstract
BackgroundThe presence of chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM) increases the risk of cardiovascular disease (CVD) regardless of the presence of traditional cardiovascular risk factors. There is controversy about the impact of each of the manifestations of CKD on the prevalence of CVD, whether it is greater with decreased estimated glomerular filtration rate (eGFR) or increased urine albumin creatinine ratio (UACR).MethodsThis study is a national cross-sectional study performed in primary care consults. We selected participants of both sexes who were aged 40 years or older, had been diagnosed with T2DM and had complete information on the study variables recorded in their medical records. The participants were classified according to eGFR : ≥ 60; 45–59; 30–44; <30 mL/min/1.73 m2 and UACR : < 30; 30–299; ≥300 mg/gr. The results were adjusted to compare the prevalence of CVD across all categories.ResultsA total of 1141 participants were included. Compared to participants with eGFR > 60 mL/min/1.73 m2 those with eGFR between 30–44 mL/min/m2, (OR = 2.3; 95% CI, 1.4-3.9); and eGFR < 30 mL/min/1.73 m2 (OR = 4.1 95% CI 1.6-10.2) showed increased likelihood of having CVD. Participants with UACR ≥ 30 mg/g compared to participants with UACR < 30 mg/g increased significantly the likelihood of having CVD, especially with UACR above 300 mg/g, (OR = 1.6; 95% CI 1.1-2.4 for UACR = 30–299 mg/g; OR = 3.9; CI 1.6-9.5 for UACR ≥ 300 mg/g).ConclusionThe decrease in eGFR and increase in UACR are independent risk factors that increase the prevalence of CVD in participants with T2DM and these factors are independent of each other and of other known cardiovascular risk factors. In our study the impact of mild decreased eGFR in T2DM on CVD was lower than the impact of increased UACR. It is necessary to determine not only UACR but also eGFR for all patients with T2DM, both at the time of diagnosis and during follow-up, to identify those patients at high risk of cardiovascular complications.
Highlights
The presence of chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM) increases the risk of cardiovascular disease (CVD) regardless of the presence of traditional cardiovascular risk factors
In some studies in patients with T2DM, it has been observed that increased urine albumin creatinine ratio (UACR) and decreased estimated glomerular filtration rate (eGFR) are associated with the same prevalence of CVD, the increase in UACR seems to relate more strongly to cardiovascular death [11,12]
In this study, we observed that in participants with T2DM treated in primary care settings, decreased eGFR and increased UACR were associated with a higher rate of cardiovascular disease
Summary
The presence of chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM) increases the risk of cardiovascular disease (CVD) regardless of the presence of traditional cardiovascular risk factors. There is controversy about the impact of each of the manifestations of CKD on the prevalence of CVD, whether it is greater with decreased estimated glomerular filtration rate (eGFR) or increased urine albumin creatinine ratio (UACR). Chronic kidney disease (CKD) is a serious public health problem that increases the risk of overall mortality, cardiovascular disease (CVD), and progression to end-stage renal disease regardless of the presence of traditional cardiovascular risk factors [1,2,3]. The presence of microalbuminuria in diabetes mellitus has been considered one of the first clinical signs of Controversy exists regarding the impact of each of the manifestations of CKD on the prevalence of CVD, whether it would be greater with increased urine albumin creatinine ratio (UACR) or a decreased eGFR. The decrease in eGFR and increase in UACR are independently associated with increased overall mortality [11] and high prevalence of CVD [16,17], which are even higher if they are both present
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