Total and cardiovascular mortality risk according to KDIGO guidelines classification in type 2 diabetic patients

Background and aims: Our aim was to assess the usefulness of KDIGO 2012 risk classification to predict total and cardiovascular mortality in type 2 diabetes mellitus (DM2). Material and methods: Prospective cohort study that included DM2 patients. Clinical end-points were total and cardiovascular mortality. The main predictive variable was KDIGO risk classification, which is a combination of urinary albumin excretion and glomerular filtration rate. The predictive value was evaluated by the integrated discrimination improvement (IDI) index. Results: 453 patients (39.3% males, aged 64.9 [SD 9.3] and with a mean diabetes duration of 10.4 [SD 7.5] years) were included. During a median follow-up of 13 years, mortality rates per 1000 patients/year (26.5 vs. 45.1 vs. 79,2 vs. 109,8; p<0,001) and cardiovascular mortality (8.1 vs. 17.4 vs. 24.7 vs. 57.5: p< 0,001) were progressively increased in successive KDIGO categories. In the multivariate analysis, there was also a progressive increase of mortality risk (HR[moderate risk] =1.29; HR[high risk]) = 1.83; HR[very high risk] = 2.15; p = .016) and cardiovascular mortality risk (HR[moderate risk] =1.73; HR[high risk] = 2.27; HR[very high risk] = 4.22; p =.007) in the successive categories. KDIGO classification was able to improve the mortality risk prediction (IDI= 0.00888; p = .047) and cardiovascular mortality risk prediction (IDI = 0.01813; p = .035). Conclusions: KDIGO risk classification can effectively stratify total and cardiovascular mortality risk in DM2 patients. (C) 2019 Elsevier Espana, S.L.U. All rights reserved.