Cardiovascular and all-cause mortality in patients with type 2 diabetes mellitus in the MADIABETES Cohort Study: Association with chronic kidney disease

Aims To assess the prevalence of stage 3–5 chronic kidney disease (CKD) at baseline and to identify associated risk factors. To determine the effect of CKD and CKD stage according to estimated glomerular filtration rate (eGFR) and albuminuria categories on all-cause and cardiovascular mortality after a 5-year follow-up. Methods Prospective cohort study of 3443 outpatients with type 2 diabetes mellitus. Results The prevalence of CKD was 28.32% (95% CI, 26.84–29.86); and variables most strongly associated were: age >74years (OR, 19.88; 95% CI, 12.89–30.68) and albuminuria (OR, 2.27; 95% CI, 1.72–3.00).During follow-up, 221 CKD patients (22.90%) died compared with 203 non-CKD patients (8.31%) (p<0.01).The adjusted HR of CKD for cardiovascular and all-cause mortality was 1.82 (95% CI, 1.36–2.44) and 2.11 (95% CI, 1.61–2.76) for those with LDL cholesterol =135mg/dl, respectively. The adjusted HR of very-high-risk CKD for all-cause mortality was 4.44 (95% CI, 2.31–8.53) in aged <75years and 1.80 (95% CI, 1.19–2.72) in aged ≥75years. Conclusions CKD at baseline is an independent risk factor for all-cause and cardiovascular mortality in the overall cohort, men and women, or in primary and secondary prevention of coronary heart disease. Albuminuria is an independent risk factor for all-cause and cardiovascular mortality only in primary prevention.