Defining the contribution of chronic kidney disease to all-cause mortality in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study

G Penno, Anna Solini, Enzo Bonora, E Orsi, C Fondelli, G Zerbini, R Trevisan, M Vedovato, F Cavalot, L Laviola, Antonio Nicolucci, Giuseppe Pugliese, for the Renal Insufficiency and Cardiovascular Events (RIACE) Study Group

Research output: Contribution to journalArticle

Abstract

Aims: To define the contribution of chronic kidney disease (CKD) to excess mortality in patients with type 2 diabetes and identify the baseline variables associated with all-cause death in those with and without CKD using the RECursive Partitioning and Amalgamation (RECPAM) method.Methods: This observational, longitudinal, cohort study enrolled 15,773 consecutive non-dialytic patients with type 2 diabetes in 19 Diabetes Clinics throughout Italy in 2006–2008. Based on the presence of albuminuria ≥ 30 mg day −1 and/or estimated glomerular filtration rate (eGFR) < 60 mL min −1 ·1.73 m −2 at baseline, patients were classified as having or not CKD. Vital status was verified on October 31, 2015 for 99.26% of patients. Results: Mortality increased with increasing albuminuria and eGFR category. Excess risk versus the general population was maximal in patients aged < 55 years in the worse albuminuria or eGFR category. Conversely, in subjects aged ≥ 75 years with albuminuria < 10 mg day −1 or eGFR ≥ 75 mL min −1 ·1.73 m −2 , excess mortality was no longer detectable. At RECPAM analysis, the main correlates of death in the whole cohort were albuminuria > 44 mg day −1 , prevalent CVD, and eGFR < ~ 75 mL min −1 ·1.73 m −2 ; gender, prevalent CVD, and higher albuminuria in the normoalbuminuric range, in patients without CKD; and CVD, eGFR ~ < 50 mL min −1 ·1.73 m −2 , and albuminuria > 53 mg day −1 , in those with CKD.Conclusions: CKD is a major contributor to excess mortality in type 2 diabetes, conferring a very high risk in younger patients and fully accounting for excess risk in the older ones. Higher albuminuria and lower eGFR, even in the normal range, identify individuals with increased mortality risk. Trial registration ClinicalTrials.gov (NCT00715481; https://clinicaltrials.gov/ct2/show/NCT00715481). © 2018 Springer-Verlag Italia S.r.l., part of Springer Nature
Original languageEnglish
Pages (from-to)603-612
Number of pages10
JournalActa Diabetologica
Volume55
Issue number6
DOIs
Publication statusPublished - 2018

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Chronic Renal Insufficiency
Type 2 Diabetes Mellitus
Multicenter Studies
Renal Insufficiency
Glomerular Filtration Rate
Albuminuria
Mortality
Italy
Longitudinal Studies
Cause of Death
Reference Values
Cohort Studies

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Defining the contribution of chronic kidney disease to all-cause mortality in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study. / Penno, G; Solini, Anna; Bonora, Enzo; Orsi, E; Fondelli, C; Zerbini, G; Trevisan, R; Vedovato, M; Cavalot, F; Laviola, L; Nicolucci, Antonio; Pugliese, Giuseppe; Group, for the Renal Insufficiency and Cardiovascular Events (RIACE) Study.

In: Acta Diabetologica, Vol. 55, No. 6, 2018, p. 603-612.

Research output: Contribution to journalArticle

Penno, G, Solini, A, Bonora, E, Orsi, E, Fondelli, C, Zerbini, G, Trevisan, R, Vedovato, M, Cavalot, F, Laviola, L, Nicolucci, A, Pugliese, G & Group, FTRIACERIACES 2018, 'Defining the contribution of chronic kidney disease to all-cause mortality in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study', Acta Diabetologica, vol. 55, no. 6, pp. 603-612. https://doi.org/10.1007/s00592-018-1133-z
Penno, G ; Solini, Anna ; Bonora, Enzo ; Orsi, E ; Fondelli, C ; Zerbini, G ; Trevisan, R ; Vedovato, M ; Cavalot, F ; Laviola, L ; Nicolucci, Antonio ; Pugliese, Giuseppe ; Group, for the Renal Insufficiency and Cardiovascular Events (RIACE) Study. / Defining the contribution of chronic kidney disease to all-cause mortality in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study. In: Acta Diabetologica. 2018 ; Vol. 55, No. 6. pp. 603-612.
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abstract = "Aims: To define the contribution of chronic kidney disease (CKD) to excess mortality in patients with type 2 diabetes and identify the baseline variables associated with all-cause death in those with and without CKD using the RECursive Partitioning and Amalgamation (RECPAM) method.Methods: This observational, longitudinal, cohort study enrolled 15,773 consecutive non-dialytic patients with type 2 diabetes in 19 Diabetes Clinics throughout Italy in 2006–2008. Based on the presence of albuminuria ≥ 30 mg day −1 and/or estimated glomerular filtration rate (eGFR) < 60 mL min −1 ·1.73 m −2 at baseline, patients were classified as having or not CKD. Vital status was verified on October 31, 2015 for 99.26{\%} of patients. Results: Mortality increased with increasing albuminuria and eGFR category. Excess risk versus the general population was maximal in patients aged < 55 years in the worse albuminuria or eGFR category. Conversely, in subjects aged ≥ 75 years with albuminuria < 10 mg day −1 or eGFR ≥ 75 mL min −1 ·1.73 m −2 , excess mortality was no longer detectable. At RECPAM analysis, the main correlates of death in the whole cohort were albuminuria > 44 mg day −1 , prevalent CVD, and eGFR < ~ 75 mL min −1 ·1.73 m −2 ; gender, prevalent CVD, and higher albuminuria in the normoalbuminuric range, in patients without CKD; and CVD, eGFR ~ < 50 mL min −1 ·1.73 m −2 , and albuminuria > 53 mg day −1 , in those with CKD.Conclusions: CKD is a major contributor to excess mortality in type 2 diabetes, conferring a very high risk in younger patients and fully accounting for excess risk in the older ones. Higher albuminuria and lower eGFR, even in the normal range, identify individuals with increased mortality risk. Trial registration ClinicalTrials.gov (NCT00715481; https://clinicaltrials.gov/ct2/show/NCT00715481). {\circledC} 2018 Springer-Verlag Italia S.r.l., part of Springer Nature",
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T1 - Defining the contribution of chronic kidney disease to all-cause mortality in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study

AU - Penno, G

AU - Solini, Anna

AU - Bonora, Enzo

AU - Orsi, E

AU - Fondelli, C

AU - Zerbini, G

AU - Trevisan, R

AU - Vedovato, M

AU - Cavalot, F

AU - Laviola, L

AU - Nicolucci, Antonio

AU - Pugliese, Giuseppe

AU - Group, for the Renal Insufficiency and Cardiovascular Events (RIACE) Study

PY - 2018

Y1 - 2018

N2 - Aims: To define the contribution of chronic kidney disease (CKD) to excess mortality in patients with type 2 diabetes and identify the baseline variables associated with all-cause death in those with and without CKD using the RECursive Partitioning and Amalgamation (RECPAM) method.Methods: This observational, longitudinal, cohort study enrolled 15,773 consecutive non-dialytic patients with type 2 diabetes in 19 Diabetes Clinics throughout Italy in 2006–2008. Based on the presence of albuminuria ≥ 30 mg day −1 and/or estimated glomerular filtration rate (eGFR) < 60 mL min −1 ·1.73 m −2 at baseline, patients were classified as having or not CKD. Vital status was verified on October 31, 2015 for 99.26% of patients. Results: Mortality increased with increasing albuminuria and eGFR category. Excess risk versus the general population was maximal in patients aged < 55 years in the worse albuminuria or eGFR category. Conversely, in subjects aged ≥ 75 years with albuminuria < 10 mg day −1 or eGFR ≥ 75 mL min −1 ·1.73 m −2 , excess mortality was no longer detectable. At RECPAM analysis, the main correlates of death in the whole cohort were albuminuria > 44 mg day −1 , prevalent CVD, and eGFR < ~ 75 mL min −1 ·1.73 m −2 ; gender, prevalent CVD, and higher albuminuria in the normoalbuminuric range, in patients without CKD; and CVD, eGFR ~ < 50 mL min −1 ·1.73 m −2 , and albuminuria > 53 mg day −1 , in those with CKD.Conclusions: CKD is a major contributor to excess mortality in type 2 diabetes, conferring a very high risk in younger patients and fully accounting for excess risk in the older ones. Higher albuminuria and lower eGFR, even in the normal range, identify individuals with increased mortality risk. Trial registration ClinicalTrials.gov (NCT00715481; https://clinicaltrials.gov/ct2/show/NCT00715481). © 2018 Springer-Verlag Italia S.r.l., part of Springer Nature

AB - Aims: To define the contribution of chronic kidney disease (CKD) to excess mortality in patients with type 2 diabetes and identify the baseline variables associated with all-cause death in those with and without CKD using the RECursive Partitioning and Amalgamation (RECPAM) method.Methods: This observational, longitudinal, cohort study enrolled 15,773 consecutive non-dialytic patients with type 2 diabetes in 19 Diabetes Clinics throughout Italy in 2006–2008. Based on the presence of albuminuria ≥ 30 mg day −1 and/or estimated glomerular filtration rate (eGFR) < 60 mL min −1 ·1.73 m −2 at baseline, patients were classified as having or not CKD. Vital status was verified on October 31, 2015 for 99.26% of patients. Results: Mortality increased with increasing albuminuria and eGFR category. Excess risk versus the general population was maximal in patients aged < 55 years in the worse albuminuria or eGFR category. Conversely, in subjects aged ≥ 75 years with albuminuria < 10 mg day −1 or eGFR ≥ 75 mL min −1 ·1.73 m −2 , excess mortality was no longer detectable. At RECPAM analysis, the main correlates of death in the whole cohort were albuminuria > 44 mg day −1 , prevalent CVD, and eGFR < ~ 75 mL min −1 ·1.73 m −2 ; gender, prevalent CVD, and higher albuminuria in the normoalbuminuric range, in patients without CKD; and CVD, eGFR ~ < 50 mL min −1 ·1.73 m −2 , and albuminuria > 53 mg day −1 , in those with CKD.Conclusions: CKD is a major contributor to excess mortality in type 2 diabetes, conferring a very high risk in younger patients and fully accounting for excess risk in the older ones. Higher albuminuria and lower eGFR, even in the normal range, identify individuals with increased mortality risk. Trial registration ClinicalTrials.gov (NCT00715481; https://clinicaltrials.gov/ct2/show/NCT00715481). © 2018 Springer-Verlag Italia S.r.l., part of Springer Nature

U2 - 10.1007/s00592-018-1133-z

DO - 10.1007/s00592-018-1133-z

M3 - Article

VL - 55

SP - 603

EP - 612

JO - Acta Diabetologica

JF - Acta Diabetologica

SN - 0940-5429

IS - 6

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