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The effects of AER and eGFR on outcomes of CVD in patients with T2DM in an urban community over 8 years of multifactorial treatment: the Beijing Communities Diabetes Study 18

Authors Zhang XL, Yuan MX, Wan G, Yang GR, Li D, Fu HJ, Zhu LX, Xie RR, Zhang JD, Lv YJ, Li YL, Du XP, Wang ZM, Cui XL, Liu DY, Gao Y, Cheng SY, Wang Q, Ji Y, Li GW, Yuan SY

Received 12 April 2018

Accepted for publication 15 July 2018

Published 31 August 2018 Volume 2018:14 Pages 1537—1545

DOI https://doi.org/10.2147/TCRM.S170915

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Professor Deyun Wang


Xue-Lian Zhang,1 Ming-Xia Yuan,1 Gang Wan,2 Guang-Ran Yang,1 Dong-Mei Li,3 Han-Jing Fu,1 Liang-Xiang Zhu,1 Rong-Rong Xie,1 Jian-Dong Zhang,4 Yu-Jie Lv,5 Yu-Ling Li,6 Xue-Ping Du,7 Zi-Ming Wang,8 Xue-Li Cui,9 De-Yuan Liu,10 Ying Gao,11 Shu-Yan Cheng,12 Qian Wang,13 Yu Ji,14 Guang-Wei Li,15,16 Shen-Yuan Yuan1

1Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Medical Records and Statistics Department, Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China; 3Clinical and Translational Science Institute, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA; 4Department of General Practice, Jinsong Community Health Service Center, Beijing, People’s Republic of China; 5Department of General Practice, Cuigezhuang Community Health Service Center, Beijing, People’s Republic of China; 6Department of General Practice, Xinjiekou Community Health Service Center, Beijing, People’s Republic of China; 7Department of General Practice, Yuetan Community Health Service Center of Fuxing Hospital, Capital Medical University, Beijing, People’s Republic of China; 8Department of General Practice, Jiangtai Community Health Service Center, Beijing, People’s Republic of China; 9Department of General Practice, Sanlitun Community Health Service Center, Beijing, People’s Republic of China; 10Department of General Practice, Zuojiazhuang Community Health Service Center, Beijing, People’s Republic of China; 11Department of General Practice, The First People’s Hospital of Chongwen District, Beijing, People’s Republic of China; 12Department of General Practice, Balizhuang Community Health Service Center, Beijing, People’s Republic of China; 13Department of General Practice, Majiapu Community Health Service Center, Beijing, People’s Republic of China; 14Department of Endocrinology, Beijing Aerospace General Hospital, Beijing, People’s Republic of China; 15Department of Endocrinology, China-Japan Friendship Hospital, Beijing, People’s Republic of China; 16Center of Endocrinology and Cardiovascular Disease, Department of Endocrinology, National Center of Cardiology and Fuwai Hospital, Beijing, People’s Republic of China

Objective: It is well known that diabetic kidney disease is a risk factor for cardiovascular diseases (CVD) in patients with type 2 diabetes mellitus (T2DM). In this study, the effects of urine albumin excretion rate (AER) and estimated glomerular filtration rate (eGFR) on CVD outcomes were analyzed in a population of T2DM.
Methods: The study was carried out using recorded information of a cohort study. A total of 1,914 patients with T2DM with no prevalent CVD were enrolled in an 8 years prospective study and received multifactorial intervention. The risk of CVD outcomes was assessed according to chronic kidney disease staging, which was categorized using AER (mg/d) and eGFR (mL/min/1.73 m2). The effects of AER and eGFR on risk of CVD onset were also analyzed.
Results: During the follow-up period (median 6.8 years), 71 CVD events occurred. At baseline, those with AER ≥300 mg/d and coexisting eGFR 60–89 mL/min/ 1.73 m2 or <60 mL/min/1.73 m2 showed increased risk for CVD outcomes when compared with “no chronic kidney disease” (AER <30 mg/d and eGFR ≥90 mL/min/1.73 m2). The increased CVD risk was observed in patients who progressed to AER ≥30 mg/d during the follow-up period, whereas patients who progressed to eGFR <90 mL/min/1.73 m2 alone showed no increased CVD risk. During the follow-up period, after multifactorial intervention, 8.7% patients with microalbuminuria and 1.8% patients with overt nephropathy reversed to normoalbuminuria or microalbuminuria.
Conclusion: AER is a more sensitive predictor than eGFR for CVD outcomes in T2DM patients. Overt nephropathy can be reversed after multifactorial intervention.

Keywords:
albumin excretion rate, cardiovascular disease, chronic kidney disease, diabetic nephropathy, glomerular filtration rate

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