Diabetic kidney disease phenotypes and the risk of cardiovascular events: The Silesia Diabetes-Heart Project

Abstract

Background: The impact of diabetic kidney disease (DKD) phenotype on the cardiovascular (CV) risk remains ambiguous. Methods: This was a prospective, single-center study (The Silesia Diabetes-Heart Project, NCT05626413) of people with diabetes mellitus (DM). The primary outcome was a composite of CV events during a median follow up of 2.8 years (IQR 1.7; 4.0). Individuals were divided into groups based on DKD phenotypes [reduced estimated glomerular filtration rate (eGFR) (< 60 mL/min/1.73 m2), and/or elevated urinary albumin creatinine ratio (UACR) (≥ 30 mg/g)] and compared to those without DKD. Results: Among 2306 people with DM (mean age 58 ± 18 years, 51.9% males) those with DKD had higher CV events risk (aHR 1.02, 95% CI 1.01–1.03) compared to those without DKD. People with reduced eGFR (aHR 1.78, 95% CI 1.19–2.67) and those with reduced eGFR and elevated UACR (aHR 1.60, 95% CI 1.08–2.37) were at higher risk of CV events compared to people with normal eGFR and UACR, while people with elevated UACR only (aHR 0.91, 95% CI 0.62–1.32) did not had the risk heightened. Among people with DKD less frequent prescriptions with sodium-glucose co-transporter 2 inhibitors and renin–angiotensin–aldosterone system inhibitors were observed (OR 0.38, 95% CI 0.29–0.49, p < 0.001 and OR 0.39, 95% CI 0.30–0.50, p < 0.001, respectively) compared with the ones without DKD. Conclusion: People with DKD, with reduced eGFR or both reduced eGFR and elevated UACR, but not with elevated UACR alone, are at higher CV risk. Personalizing therapy based on clinic-based renal phenotyping can facilitate the initiation of CV disease modifying therapy.