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Specific impact of past and new major cardiovascular events on acute kidney injury and end-stage renal disease risks in diabetes: a dynamic view

BACKGROUND: Interconnections between major cardiovascular events (MCVEs) and renal events are recognized in diabetes, however, the specific impact of atrial fibrillation (AF), heart failure (HF) and acute coronary syndrome (ACS) on the risk of end-stage renal disease (ESRD) on top of established ren...

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Autores principales: Pinier, Cédric, Gatault, Philippe, Fauchier, Laurent, Angoulvant, Denis, François, Maud, Barbet, Christelle, Bailly, Elodie, Noble, Johan, Chevallier, Eloi, Rabot, Nolwenn, Büchler, Matthias, Sautenet, Bénédicte, Halimi, Jean-Michel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7025370/
https://www.ncbi.nlm.nih.gov/pubmed/32083616
http://dx.doi.org/10.1093/ckj/sfz028
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author Pinier, Cédric
Gatault, Philippe
Fauchier, Laurent
Angoulvant, Denis
François, Maud
Barbet, Christelle
Bailly, Elodie
Noble, Johan
Chevallier, Eloi
Rabot, Nolwenn
Büchler, Matthias
Sautenet, Bénédicte
Halimi, Jean-Michel
author_facet Pinier, Cédric
Gatault, Philippe
Fauchier, Laurent
Angoulvant, Denis
François, Maud
Barbet, Christelle
Bailly, Elodie
Noble, Johan
Chevallier, Eloi
Rabot, Nolwenn
Büchler, Matthias
Sautenet, Bénédicte
Halimi, Jean-Michel
author_sort Pinier, Cédric
collection PubMed
description BACKGROUND: Interconnections between major cardiovascular events (MCVEs) and renal events are recognized in diabetes, however, the specific impact of atrial fibrillation (AF), heart failure (HF) and acute coronary syndrome (ACS) on the risk of end-stage renal disease (ESRD) on top of established renal risk factors is unclear in type 2 diabetes mellitus. METHODS: We conducted a retrospective study in 861 consecutive patients followed in a nephrology setting during the 2000–13 period. RESULTS: The mean age was 70 ± 10 years, 65.1% were men and the estimated glomerular filtration rate (eGFR) was 42.4 ± 21.0 mL/min/1.73 m(2). During follow-up (median 59 months), 194 patients reached ESRD. A history of AF, HF or ACS was associated with an increased risk of reduced baseline eGFR. In turn, reduced baseline eGFR resulted in a greater risk of new MCVE (especially HF) during follow-up. Finally, all new MCVEs were risk factors for subsequent acute kidney injury (AKI) {HF: hazard ratio [HR] 8.99 [95% confidence interval (CI) 7.06–11.4]; AF: HR 5.42 (3.91–7.52); ACS: HR 8.82 (6.24–12.5); all P < 0.0001} and ESRD [HF: HR 5.52 (95% CI 4.01–7.60), P < 0.0001; AF: HR 3.48 (2.30–5.21), P < 0.0001; ACS: HR 2.31 (1.43–3.73), P = 0.0006]. The AF- and HF-associated risks of ESRD were significant after adjustments on all renal risks of ESRD (gender, blood pressure, eGFR, albuminuria, renin–angiotensin blockers, retinopathy and AKI), but the association was less strong for ACS. Importantly, no association was noted between other major events such as stroke or infections and the risk of ESRD. CONCLUSIONS: Past and new cardiovascular events (more HF and AF than ACS) have a strong, independent impact on the development of ESRD above and beyond established risk factors in diabetes.
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spelling pubmed-70253702020-02-20 Specific impact of past and new major cardiovascular events on acute kidney injury and end-stage renal disease risks in diabetes: a dynamic view Pinier, Cédric Gatault, Philippe Fauchier, Laurent Angoulvant, Denis François, Maud Barbet, Christelle Bailly, Elodie Noble, Johan Chevallier, Eloi Rabot, Nolwenn Büchler, Matthias Sautenet, Bénédicte Halimi, Jean-Michel Clin Kidney J Diabetic Kidney Disease BACKGROUND: Interconnections between major cardiovascular events (MCVEs) and renal events are recognized in diabetes, however, the specific impact of atrial fibrillation (AF), heart failure (HF) and acute coronary syndrome (ACS) on the risk of end-stage renal disease (ESRD) on top of established renal risk factors is unclear in type 2 diabetes mellitus. METHODS: We conducted a retrospective study in 861 consecutive patients followed in a nephrology setting during the 2000–13 period. RESULTS: The mean age was 70 ± 10 years, 65.1% were men and the estimated glomerular filtration rate (eGFR) was 42.4 ± 21.0 mL/min/1.73 m(2). During follow-up (median 59 months), 194 patients reached ESRD. A history of AF, HF or ACS was associated with an increased risk of reduced baseline eGFR. In turn, reduced baseline eGFR resulted in a greater risk of new MCVE (especially HF) during follow-up. Finally, all new MCVEs were risk factors for subsequent acute kidney injury (AKI) {HF: hazard ratio [HR] 8.99 [95% confidence interval (CI) 7.06–11.4]; AF: HR 5.42 (3.91–7.52); ACS: HR 8.82 (6.24–12.5); all P < 0.0001} and ESRD [HF: HR 5.52 (95% CI 4.01–7.60), P < 0.0001; AF: HR 3.48 (2.30–5.21), P < 0.0001; ACS: HR 2.31 (1.43–3.73), P = 0.0006]. The AF- and HF-associated risks of ESRD were significant after adjustments on all renal risks of ESRD (gender, blood pressure, eGFR, albuminuria, renin–angiotensin blockers, retinopathy and AKI), but the association was less strong for ACS. Importantly, no association was noted between other major events such as stroke or infections and the risk of ESRD. CONCLUSIONS: Past and new cardiovascular events (more HF and AF than ACS) have a strong, independent impact on the development of ESRD above and beyond established risk factors in diabetes. Oxford University Press 2019-04-16 /pmc/articles/PMC7025370/ /pubmed/32083616 http://dx.doi.org/10.1093/ckj/sfz028 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Diabetic Kidney Disease
Pinier, Cédric
Gatault, Philippe
Fauchier, Laurent
Angoulvant, Denis
François, Maud
Barbet, Christelle
Bailly, Elodie
Noble, Johan
Chevallier, Eloi
Rabot, Nolwenn
Büchler, Matthias
Sautenet, Bénédicte
Halimi, Jean-Michel
Specific impact of past and new major cardiovascular events on acute kidney injury and end-stage renal disease risks in diabetes: a dynamic view
title Specific impact of past and new major cardiovascular events on acute kidney injury and end-stage renal disease risks in diabetes: a dynamic view
title_full Specific impact of past and new major cardiovascular events on acute kidney injury and end-stage renal disease risks in diabetes: a dynamic view
title_fullStr Specific impact of past and new major cardiovascular events on acute kidney injury and end-stage renal disease risks in diabetes: a dynamic view
title_full_unstemmed Specific impact of past and new major cardiovascular events on acute kidney injury and end-stage renal disease risks in diabetes: a dynamic view
title_short Specific impact of past and new major cardiovascular events on acute kidney injury and end-stage renal disease risks in diabetes: a dynamic view
title_sort specific impact of past and new major cardiovascular events on acute kidney injury and end-stage renal disease risks in diabetes: a dynamic view
topic Diabetic Kidney Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7025370/
https://www.ncbi.nlm.nih.gov/pubmed/32083616
http://dx.doi.org/10.1093/ckj/sfz028
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