Risk of cardiovascular disease, death, and renal progression in diabetes according to albuminuria and estimated glomerular filtration rate

Aim: We aimed to examine risks of major cardiovascular events (MACEs), renal outcomes, and all-cause mortality in type 2 diabetes mellitus (T2DM) patients with different diabetic kidney disease (DKD) subtypes.Methods: A total of 36,509 participants with T2DM recruited from 20 community sites across mainland China were followed up during 2011-2016. DKD subtypes were categorized based on albuminuria (urinary albumin-to-creatinine ratio, UACR >= 30 mg/g) and reduced estimated glomerular filtration rate (eGFR < 60 ml/min/1.73 m2) as Alb-/eGFR-, Alb'/eGFR-, Alb-/eGFR', and Alb'/eGFR'. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) of developing clinical outcomes in DKD subtypes.Results: More than half (53.5%) of participants with diabetes and reduced eGFR had normal UACR levels (Alb-/ eGFR'), termed as non-albuminuria DKD. These patients had a modest increase in the risks of MACEs (hazard ratio, HR 1.42 [95% CI 1.08;1.88]) and mortality (HR 1.42 [1.04;1.92]) compared with patients without DKD, whereas CKD progression was not significantly increased (HR 0.97 [0.60;1.57]). Participants with albuminuria (Alb'/eGFR- or Alb'/eGFR') had higher risks of clinical outcomes. Subgroup analysis revealed that the associations between non-albuminuria DKD and risks of MACEs and mortality were more evident in those aged <65 years.Conclusion: Non-albuminuria DKD accounts for more than half of DKD cases with low eGFR in Chinese diabe-tes patients. Diabetes patients with albuminuria are at higher risks of developing clinical outcomes and war-rant early intervention, as well as patients with non-albuminuria DKD with age < 65 years.(c) 2023 Elsevier Masson SAS. All rights reserved.