Albuminuria and Kidney Function Independently Predict Cardiovascular and Renal Outcomes in Diabetes
Identifieur interne : 008475 ( Main/Exploration ); précédent : 008474; suivant : 008476Albuminuria and Kidney Function Independently Predict Cardiovascular and Renal Outcomes in Diabetes
Auteurs : Toshiharu Ninomiya [Australie] ; Vlado Perkovic [Australie] ; Bastiaan E. De Galan [Australie, Pays-Bas] ; Sophia Zoungas [Australie] ; Avinesh Pillai [Australie] ; Meg Jardine [Australie] ; Anushka Patel [Australie] ; Alan Cass [Australie] ; Bruce Neal [Australie] ; Neil Poulter [Royaume-Uni] ; Carl-Erik Mogensen [Danemark] ; Mark Cooper [Australie] ; Michel Marre [France] ; Bryan Williams [Royaume-Uni] ; Pavel Hamet [Canada] ; Giuseppe Mancia [Italie] ; Mark Woodward [Australie, États-Unis] ; Stephen Macmahon [Australie] ; John Chalmers [Australie]Source :
- Journal of the American Society of Nephrology [ 1046-6673 ] ; 2009.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Diabète.
English descriptors
- KwdEn :
Abstract
There are limited data regarding whether albuminuria and reduced estimated GFR (eGFR) are separate and independent risk factors for cardiovascular and renal events among individuals with type 2 diabetes. The Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study examined the effects of routine BP lowering on adverse outcomes in type 2 diabetes. We investigated the effects of urinary albumin-to-creatinine ratio (UACR) and eGFR on the risk for cardiovascular and renal events in 10,640 patients with available data. During an average 4.3-yr follow-up, 938 (8.8%) patients experienced a cardiovascular event and 107 (1.0%) experienced a renal event. The multivariable-adjusted hazard ratio for cardiovascular events was 2.48 (95% confidence interval 1.74 to 3.52) for every 10-fold increase in baseline UACR and 2.20 (95% confidence interval 1.09 to 4.43) for every halving of baseline eGFR, after adjustment for regression dilution. There was no evidence of interaction between the effects of higher UACR and lower eGFR. Patients with both UACR >300 mg/g and eGFR <60 ml/min per 1.73 m2 at baseline had a 3.2-fold higher risk for cardiovascular events and a 22.2-fold higher risk for renal events, compared with patients with neither of these risk factors. In conclusion, high albuminuria and low eGFR are independent risk factors for cardiovascular and renal events among patients with type 2 diabetes.
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Affiliations:
- Australie, Canada, Danemark, France, Italie, Pays-Bas, Royaume-Uni, États-Unis
- Angleterre, Grand Londres, Gueldre, Lombardie, Nouvelle-Galles du Sud, Québec, Victoria (État), État de New York, Île-de-France
- Londres, Melbourne, Milan, Montréal, Nimègue, Paris, Sydney
- Université de Sydney
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sortKey="Zoungas, Sophia" sort="Zoungas, Sophia" uniqKey="Zoungas S" first="Sophia" last="Zoungas">Sophia Zoungas</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>George Institute for International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>17 aut.</sZ><sZ>18 aut.</sZ><sZ>19 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Pillai, Avinesh" sort="Pillai, Avinesh" uniqKey="Pillai A" first="Avinesh" last="Pillai">Avinesh Pillai</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>George Institute for International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>17 aut.</sZ><sZ>18 aut.</sZ><sZ>19 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Jardine, Meg" sort="Jardine, Meg" uniqKey="Jardine M" first="Meg" last="Jardine">Meg Jardine</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>George Institute for International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>17 aut.</sZ><sZ>18 aut.</sZ><sZ>19 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Patel, Anushka" sort="Patel, Anushka" uniqKey="Patel A" first="Anushka" last="Patel">Anushka Patel</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>George Institute for International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>17 aut.</sZ><sZ>18 aut.</sZ><sZ>19 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Cass, Alan" sort="Cass, Alan" uniqKey="Cass A" first="Alan" last="Cass">Alan Cass</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>George Institute for International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>17 aut.</sZ><sZ>18 aut.</sZ><sZ>19 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Neal, Bruce" sort="Neal, Bruce" uniqKey="Neal B" first="Bruce" last="Neal">Bruce Neal</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>George Institute for International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>17 aut.</sZ><sZ>18 aut.</sZ><sZ>19 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Poulter, Neil" sort="Poulter, Neil" uniqKey="Poulter N" first="Neil" last="Poulter">Neil Poulter</name><affiliation wicri:level="3"><inist:fA14 i1="03"><s1>International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London</s1><s2>London</s2><s3>GBR</s3><sZ>10 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Mogensen, Carl Erik" sort="Mogensen, Carl Erik" uniqKey="Mogensen C" first="Carl-Erik" last="Mogensen">Carl-Erik Mogensen</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Medical Department M, Aarhus University Hospital, Aarhus Sygehus</s1><s2>Aarhus C</s2><s3>DNK</s3><sZ>11 aut.</sZ></inist:fA14><country>Danemark</country><wicri:noRegion>Aarhus C</wicri:noRegion></affiliation></author><author><name sortKey="Cooper, Mark" sort="Cooper, Mark" uniqKey="Cooper M" first="Mark" last="Cooper">Mark Cooper</name><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Danielle Alberti Memorial Centre for Diabetes Complications, Baker Heart Research Institute</s1><s2>Melbourne</s2><s3>AUS</s3><sZ>12 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation></author><author><name sortKey="Marre, Michel" sort="Marre, Michel" uniqKey="Marre M" first="Michel" last="Marre">Michel Marre</name><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Service d'Endocrinologie Diabétologie Nutrition, Groupe Hospitalier Bichat-Claude Bernard</s1><s2>Paris</s2><s3>FRA</s3><sZ>13 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Williams, Bryan" sort="Williams, Bryan" uniqKey="Williams B" first="Bryan" last="Williams">Bryan Williams</name><affiliation wicri:level="1"><inist:fA14 i1="07"><s1>Department of Cardiovascular Sciences, University of Leicester School of Medicine</s1><s2>Leicester</s2><s3>GBR</s3><sZ>14 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Leicester</wicri:noRegion></affiliation></author><author><name sortKey="Hamet, Pavel" sort="Hamet, Pavel" uniqKey="Hamet P" first="Pavel" last="Hamet">Pavel Hamet</name><affiliation wicri:level="3"><inist:fA14 i1="08"><s1>Research Centre, Centre hospitalier de l'Université de Montréal</s1><s2>Montreal</s2><s3>CAN</s3><sZ>15 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Montréal</settlement><region type="state">Québec</region></placeName></affiliation></author><author><name sortKey="Mancia, Giuseppe" sort="Mancia, Giuseppe" uniqKey="Mancia G" first="Giuseppe" last="Mancia">Giuseppe Mancia</name><affiliation wicri:level="3"><inist:fA14 i1="09"><s1>Department of Clinical Medicine and Prevention, University of Milano-Bicocca</s1><s2>Milan</s2><s3>ITA</s3><sZ>16 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>George Institute for International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>17 aut.</sZ><sZ>18 aut.</sZ><sZ>19 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation><affiliation wicri:level="2"><inist:fA14 i1="10"><s1>Mount Sinai School of Medicine</s1><s2>New York, New York</s2><s3>USA</s3><sZ>17 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Macmahon, Stephen" sort="Macmahon, Stephen" uniqKey="Macmahon S" first="Stephen" last="Macmahon">Stephen Macmahon</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>George Institute for International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>17 aut.</sZ><sZ>18 aut.</sZ><sZ>19 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Chalmers, John" sort="Chalmers, John" uniqKey="Chalmers J" first="John" last="Chalmers">John Chalmers</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>George Institute for International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>17 aut.</sZ><sZ>18 aut.</sZ><sZ>19 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author></analytic><series><title level="j" type="main">Journal of the American Society of Nephrology</title><title level="j" type="abbreviated">J. Am. Soc. Nephrol.</title><idno type="ISSN">1046-6673</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Journal of the American Society of Nephrology</title><title level="j" type="abbreviated">J. Am. Soc. Nephrol.</title><idno type="ISSN">1046-6673</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Circulatory system</term><term>Diabetes mellitus</term><term>Kidney</term><term>Nephrology</term><term>Predictive factor</term><term>Prognosis</term><term>Proteinuria</term><term>Renal function</term><term>Urology</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Protéinurie</term><term>Fonction rénale</term><term>Facteur prédictif</term><term>Diabète</term><term>Appareil circulatoire</term><term>Rein</term><term>Pronostic</term><term>Néphrologie</term><term>Urologie</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Diabète</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">There are limited data regarding whether albuminuria and reduced estimated GFR (eGFR) are separate and independent risk factors for cardiovascular and renal events among individuals with type 2 diabetes. The Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study examined the effects of routine BP lowering on adverse outcomes in type 2 diabetes. We investigated the effects of urinary albumin-to-creatinine ratio (UACR) and eGFR on the risk for cardiovascular and renal events in 10,640 patients with available data. During an average 4.3-yr follow-up, 938 (8.8%) patients experienced a cardiovascular event and 107 (1.0%) experienced a renal event. The multivariable-adjusted hazard ratio for cardiovascular events was 2.48 (95% confidence interval 1.74 to 3.52) for every 10-fold increase in baseline UACR and 2.20 (95% confidence interval 1.09 to 4.43) for every halving of baseline eGFR, after adjustment for regression dilution. There was no evidence of interaction between the effects of higher UACR and lower eGFR. Patients with both UACR >300 mg/g and eGFR <60 ml/min per 1.73 m<sup>2</sup> at baseline had a 3.2-fold higher risk for cardiovascular events and a 22.2-fold higher risk for renal events, compared with patients with neither of these risk factors. In conclusion, high albuminuria and low eGFR are independent risk factors for cardiovascular and renal events among patients with type 2 diabetes.</div></front></TEI><affiliations><list><country><li>Australie</li><li>Canada</li><li>Danemark</li><li>France</li><li>Italie</li><li>Pays-Bas</li><li>Royaume-Uni</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Grand Londres</li><li>Gueldre</li><li>Lombardie</li><li>Nouvelle-Galles du Sud</li><li>Québec</li><li>Victoria (État)</li><li>État de New York</li><li>Île-de-France</li></region><settlement><li>Londres</li><li>Melbourne</li><li>Milan</li><li>Montréal</li><li>Nimègue</li><li>Paris</li><li>Sydney</li></settlement><orgName><li>Université de Sydney</li></orgName></list><tree><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Ninomiya, Toshiharu" sort="Ninomiya, Toshiharu" uniqKey="Ninomiya T" first="Toshiharu" last="Ninomiya">Toshiharu Ninomiya</name></region><name sortKey="Cass, Alan" sort="Cass, Alan" uniqKey="Cass A" first="Alan" last="Cass">Alan Cass</name><name sortKey="Chalmers, John" sort="Chalmers, John" uniqKey="Chalmers J" first="John" last="Chalmers">John Chalmers</name><name sortKey="Cooper, Mark" sort="Cooper, Mark" uniqKey="Cooper M" first="Mark" last="Cooper">Mark Cooper</name><name sortKey="De Galan, Bastiaan E" sort="De Galan, Bastiaan E" uniqKey="De Galan B" first="Bastiaan E." last="De Galan">Bastiaan E. De Galan</name><name sortKey="Jardine, Meg" sort="Jardine, Meg" uniqKey="Jardine M" first="Meg" last="Jardine">Meg Jardine</name><name sortKey="Macmahon, Stephen" sort="Macmahon, Stephen" uniqKey="Macmahon S" first="Stephen" last="Macmahon">Stephen Macmahon</name><name sortKey="Neal, Bruce" sort="Neal, Bruce" uniqKey="Neal B" first="Bruce" last="Neal">Bruce Neal</name><name sortKey="Patel, Anushka" sort="Patel, Anushka" uniqKey="Patel A" first="Anushka" last="Patel">Anushka Patel</name><name sortKey="Perkovic, Vlado" sort="Perkovic, Vlado" uniqKey="Perkovic V" first="Vlado" last="Perkovic">Vlado Perkovic</name><name sortKey="Pillai, Avinesh" sort="Pillai, Avinesh" uniqKey="Pillai A" first="Avinesh" last="Pillai">Avinesh Pillai</name><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name><name sortKey="Zoungas, Sophia" sort="Zoungas, Sophia" uniqKey="Zoungas S" first="Sophia" last="Zoungas">Sophia Zoungas</name></country><country name="Pays-Bas"><region name="Gueldre"><name sortKey="De Galan, Bastiaan E" sort="De Galan, Bastiaan E" uniqKey="De Galan B" first="Bastiaan E." last="De Galan">Bastiaan E. De Galan</name></region></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Poulter, Neil" sort="Poulter, Neil" uniqKey="Poulter N" first="Neil" last="Poulter">Neil Poulter</name></region><name sortKey="Williams, Bryan" sort="Williams, Bryan" uniqKey="Williams B" first="Bryan" last="Williams">Bryan Williams</name></country><country name="Danemark"><noRegion><name sortKey="Mogensen, Carl Erik" sort="Mogensen, Carl Erik" uniqKey="Mogensen C" first="Carl-Erik" last="Mogensen">Carl-Erik Mogensen</name></noRegion></country><country name="France"><region name="Île-de-France"><name sortKey="Marre, Michel" sort="Marre, Michel" uniqKey="Marre M" first="Michel" last="Marre">Michel Marre</name></region></country><country name="Canada"><region name="Québec"><name sortKey="Hamet, Pavel" sort="Hamet, Pavel" uniqKey="Hamet P" first="Pavel" last="Hamet">Pavel Hamet</name></region></country><country name="Italie"><region name="Lombardie"><name sortKey="Mancia, Giuseppe" sort="Mancia, Giuseppe" uniqKey="Mancia G" first="Giuseppe" last="Mancia">Giuseppe Mancia</name></region></country><country name="États-Unis"><region name="État de New York"><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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