CKD predicts mortality in diabetes
Chronic kidney disease (CKD) — as defined by higher serum creatinine or lower estimated glomerular filtration rate (eGFR) and/or the presence of proteinuria — was found to be an important predictor of death in a review of 22 randomized controlled trials involving more than 90,000 adults with type 2 diabetes (J Am Heart Assoc. 2012;1:8-15).
The studies were categorized into four groups according to annual mortality rates: <1, ≥1 to <2, ≥2 to < 4, and ≥4 per 100 patient-years. Mortality rates ranged from 0.28 to 8.24 per 100 patient-years.
Although the mortality rates were higher in the trials enrolling participants with prior cardiovascular problems, the selection for CKD was associated with the highest mortality rates. Trials in which inclusion required elevated serum creatinine values (mostly >1.5 mg/dL) or eGFR <60, and/or evident proteinuria, showed the highest mortality rates: 5.9 to 8.24 per 100 patient-years.
Patients in the highest mortality category were more likely to be older, had diabetes for longer, and had higher BP.
Hypertension was not associated with higher mortality rate. Furthermore, selection for hypertension specifically did not discriminate those at higher risk of death.