Chronic kidney disease and mortality risk among older patients with type 2 diabetes mellitus (ZODIAC-24)

Design: prospective observational cohort study. Setting: primary care. Subjects: eight hundred and ten patients, >= 65 years with T2DM. Analyses were performed in age strata: 65-75 (n = 471), > 75 (n = 339) years. Methods: Cox proportional hazard modelling was used to investigate the association between eGFR, albuminuria and all-cause and cardiovascular mortality after a median follow-up of 9.8 years. Results: an eGFR < 45 and 45-60 ml/min/1.73 m(2) is associated with increased cardiovascular mortality in patients of 65-75 years, hazard ratio (HR): 3.29 (1.58-6.86) and 1.78 (1.09-2.90), respectively; in those > 75 years increased cardiovascular mortality was observed when eGFR was < 45 ml/min/1.73 m(2): 2.42 (1.47-3.69). Compared with patients of 65-75 years, an eGFR > 60 ml/min/1.73 m(2) and normo-albuminuria, fully adjusted HRs for cardiovascular mortality were 2.26 (1.04-4.92) and 4.86 (2.33-10.15) for those aged 65-75 years, an eGFR of 45-60 ml/min/1.73 m(2) and normo-albuminuria or albuminuria, respectively; HRs were 1.33 (0.67-2.66) and 2.01 (1.02-3.94), respectively, for those > 75 years. Conclusions: an eGFR of 45-60 ml/min/1.73 m(2) in T2DM patients is associated with increased mortality in patients aged 65-75 years but not in those > 75 years. Albuminuria is associated with increased mortality in patients > 65 years.