Estimated glomerular filtration rate and albuminuria are independent predictors of cardiovascular events and mortality in type 2 diabetes mellitus: the FIELD study

Drury, P.L., Ting, T-D., Zannino, D., Ehnholm, C., Flack, J., Whiting, M., Fassett, R., Ansquer,J-C., Dixon, P., Davis, T.M.E., Pardy, C., Coleman, P. and Keetch, A. (2011) Estimated glomerular filtration rate and albuminuria are independent predictors of cardiovascular events and mortality in type 2 diabetes mellitus: the FIELD study. Diabetologia, 54 1: 1-32. doi:10.1007/s00125-010-1854-1

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Author Drury, P.L.
Ting, T-D.
Zannino, D.
Ehnholm, C.
Flack, J.
Whiting, M.
Fassett, R.
Ansquer,J-C.
Dixon, P.
Davis, T.M.E.
Pardy, C.
Coleman, P.
Keetch, A.
Title Estimated glomerular filtration rate and albuminuria are independent predictors of cardiovascular events and mortality in type 2 diabetes mellitus: the FIELD study
Journal name Diabetologia   Check publisher's open access policy
ISSN 0012-186X
0941-5602
Publication date 2011-01
Year available 2010
Sub-type Article (original research)
DOI 10.1007/s00125-010-1854-1
Volume 54
Issue 1
Start page 1
End page 32
Total pages 43
Editor 12
Place of publication Berlin, Germany
Publisher Springer-Verlag
Collection year 2011
Language eng
Formatted abstract
Aims/hypothesis:
We investigated effects of renal function and albuminuria on cardiovascular outcomes in 9,795 low-risk patients with diabetes in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study.

Methods:
Baseline and year 2 renal status were examined in relation to clinical and biochemical characteristics. Outcomes included total cardiovascular disease (CVD), cardiac and non-cardiac death over 5 years.

Results:
Lower estimated GFR (eGFR) vs eGFR ≥90 ml min-1 1.73 m-2 was a risk factor for total CVD events: (HR [95% CI] 1.14 [1.01-1.29] for eGFR 60-89 ml min-1 1.73 m-2; 1.59 [1.28-1.98] for eGFR 30-59 ml min-1 1.73 m-2; p < 0.001; adjusted for other characteristics). Albuminuria increased CVD risk, with microalbuminuria and macroalbuminuria increasing total CVD (HR 1.25 [1.01-1.54] and 1.19 [0.76-1.85], respectively; p = 0.001 for trend) when eGFR ≥90 ml min-1 1.73 m-2. CVD risk was further modified by renal status changes over the first 2 years. In multivariable analysis, 77% of the effect of eGFR and 81% of the effect of albumin:creatinine ratio were accounted for by other variables, principally low HDL-cholesterol and elevated blood pressure.

Conclusions/interpretation:
Reduced eGFR and albuminuria are independent risk factors for cardiovascular events and mortality rates in a low-risk population of mainly European ancestry. While their independent contributions to CVD risk appear small when other risk factors are considered, they remain excellent surrogate markers in clinical practice because they capture risk related to a number of other characteristics. Therefore, both should be considered when assessing prognosis and treatment strategies in patients with diabetes, and both should be included in risk models. © 2010 Springer-Verlag.
Keyword Albuminuria
Cardiovascular risk
Diabetes
Diabetic nephropathy
Fenofibrate
Glomerular filtration rate
Risk factors
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
School of Medicine Publications
 
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Created: Tue, 16 Nov 2010, 17:17:04 EST by Professor Robert Fassett on behalf of Royal Brisbane Clinical School