Abstract
Background: The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (NKF's KDOQI) staging system for chronic kidney disease (CKD) is based primarily on estimated GFR (eGFR). This study aimed at assessing whether reclassification of subjects with type 2 diabetes using two recent classifications based on both eGFR and albuminuria, the Alberta Kidney Disease Network (AKDN) and the Kidney Disease: Improving Global Outcomes (KDIGO), provides a better definition of burden from cardiovascular disease (CVD) and diabetic retinopathy (DR) than the NKF's KDOQI classification.Methods: This is a cross-sectional analysis of patients with type 2 diabetes (n = 15,773) from the Renal Insufficiency And Cardiovascular Events Italian Multicenter Study, consecutively visiting 19 Diabetes Clinics throughout Italy in years 2007-2008. Exclusion criteria were dialysis or renal transplantation. CKD was defined based on eGFR, as calculated from serum creatinine by the simplified Modification of Diet in Renal Disease Study equation, and albuminuria, as measured by immunonephelometry or immunoturbidimetry. DR was assessed by dilated fundoscopy. Prevalent CVD, total and by vascular bed, was assessed from medical history by recording previous documented major acute events.Results: Though prevalence of complications increased with increasing CKD severity with all three classifications, it differed significantly between NKF's KDOQI stages and AKDN or KDIGO risk categories. The AKDN and KDIGO systems resulted in appropriate reclassification of uncomplicated patients in the lowest risk categories and a more graded independent association with CVD and DR than the NKF's KDOQI classification. However, CVD, but not DR prevalence was higher in the lowest risk categories of the new classifications than in the lowest stages of the NKF's KDOQI, due to the inclusion of subjects with reduced eGFR without albuminuria. CVD prevalence differed also among eGFR and albuminuria categories grouped into AKDN and KDIGO risk category 1 and moderate, respectively, and to a lesser extent into higher risk categories.Conclusions: Though the new systems perform better than the NKF's KDOQI in grading complications and identifying diabetic subjects without complications, they might underestimate CVD burden in patients assigned to lower risk categories and should be tested in large prospective studies.Trial registration: ClinicalTrials.gov; NCT00715481.
| Original language | English |
|---|---|
| Article number | 59 |
| Journal | Cardiovascular Diabetology |
| Volume | 13 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Mar 13 2014 |
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Keywords
- Albuminuria
- Cardiovascular disease
- Chronic kidney disease
- Classification
- Diabetic retinopathy
- eGFR
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Endocrinology, Diabetes and Metabolism
Cite this
Distribution of cardiovascular disease and retinopathy in patients with type 2 diabetes according to different classification systems for chronic kidney disease : A cross-sectional analysis of the renal insufficiency and cardiovascular events (RIACE) Italian multicenter study. / Pugliese, Giuseppe; Solini, Anna; Bonora, Enzo; Orsi, Emanuela; Zerbini, Gianpaolo; Fondelli, Cecilia; Gruden, Gabriella; Cavalot, Franco; Lamacchia, Olga; Trevisan, Roberto; Vedovato, Monica; Penno, Giuseppe; Laviola, Luigi; Nicolucci, Antonio; Cosmo, Salvatore De; Morano, Susanna; Pugliese, Francesco; Salvi, Laura; Bollanti, Lucilla; Bazuro, Alessandra; Cavallo-Perin, Paolo; Lorenzati, Bartolomeo; Trovati, Mariella; Anfossi, Giovanni; Chirio, Massimo; Martina, Valentina; Maestroni, Silvia; Montefusco, Laura; Zimbalatti, Dario; Pontiroli, Antonio; Veronelli, Annamaria; Zecchini, Barbara; Arosio, Maura; Dolci, Alessia; Corsi, Anna; Zoppini, Giacomo; Avogaro, Angelo; Pagnin, Elisa; Pucci, Laura; Lucchesi, Daniela; Russo, Eleonora; Garofolo, Monia; Dotta, Francesco; Nigi, Laura; Gatti, Alessandra; Buzzetti, Raffaella; Foffi, Chiara; Cignarelli, Mauro; Pinnelli, Sabina; Monaco, Lucia; Giorgino, Francesco; Perrini, Sebastio; Sesti, Giorgio; Andreozzi, Francesco; Baroni, Marco Giorgio; Frau, Giuseppina.
In: Cardiovascular Diabetology, Vol. 13, No. 1, 59, 13.03.2014.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Distribution of cardiovascular disease and retinopathy in patients with type 2 diabetes according to different classification systems for chronic kidney disease
T2 - A cross-sectional analysis of the renal insufficiency and cardiovascular events (RIACE) Italian multicenter study
AU - Pugliese, Giuseppe
AU - Solini, Anna
AU - Bonora, Enzo
AU - Orsi, Emanuela
AU - Zerbini, Gianpaolo
AU - Fondelli, Cecilia
AU - Gruden, Gabriella
AU - Cavalot, Franco
AU - Lamacchia, Olga
AU - Trevisan, Roberto
AU - Vedovato, Monica
AU - Penno, Giuseppe
AU - Laviola, Luigi
AU - Nicolucci, Antonio
AU - Cosmo, Salvatore De
AU - Morano, Susanna
AU - Pugliese, Francesco
AU - Salvi, Laura
AU - Bollanti, Lucilla
AU - Bazuro, Alessandra
AU - Cavallo-Perin, Paolo
AU - Lorenzati, Bartolomeo
AU - Trovati, Mariella
AU - Anfossi, Giovanni
AU - Chirio, Massimo
AU - Martina, Valentina
AU - Maestroni, Silvia
AU - Montefusco, Laura
AU - Zimbalatti, Dario
AU - Pontiroli, Antonio
AU - Veronelli, Annamaria
AU - Zecchini, Barbara
AU - Arosio, Maura
AU - Dolci, Alessia
AU - Corsi, Anna
AU - Zoppini, Giacomo
AU - Avogaro, Angelo
AU - Pagnin, Elisa
AU - Pucci, Laura
AU - Lucchesi, Daniela
AU - Russo, Eleonora
AU - Garofolo, Monia
AU - Dotta, Francesco
AU - Nigi, Laura
AU - Gatti, Alessandra
AU - Buzzetti, Raffaella
AU - Foffi, Chiara
AU - Cignarelli, Mauro
AU - Pinnelli, Sabina
AU - Monaco, Lucia
AU - Giorgino, Francesco
AU - Perrini, Sebastio
AU - Sesti, Giorgio
AU - Andreozzi, Francesco
AU - Baroni, Marco Giorgio
AU - Frau, Giuseppina
PY - 2014/3/13
Y1 - 2014/3/13
N2 - Background: The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (NKF's KDOQI) staging system for chronic kidney disease (CKD) is based primarily on estimated GFR (eGFR). This study aimed at assessing whether reclassification of subjects with type 2 diabetes using two recent classifications based on both eGFR and albuminuria, the Alberta Kidney Disease Network (AKDN) and the Kidney Disease: Improving Global Outcomes (KDIGO), provides a better definition of burden from cardiovascular disease (CVD) and diabetic retinopathy (DR) than the NKF's KDOQI classification.Methods: This is a cross-sectional analysis of patients with type 2 diabetes (n = 15,773) from the Renal Insufficiency And Cardiovascular Events Italian Multicenter Study, consecutively visiting 19 Diabetes Clinics throughout Italy in years 2007-2008. Exclusion criteria were dialysis or renal transplantation. CKD was defined based on eGFR, as calculated from serum creatinine by the simplified Modification of Diet in Renal Disease Study equation, and albuminuria, as measured by immunonephelometry or immunoturbidimetry. DR was assessed by dilated fundoscopy. Prevalent CVD, total and by vascular bed, was assessed from medical history by recording previous documented major acute events.Results: Though prevalence of complications increased with increasing CKD severity with all three classifications, it differed significantly between NKF's KDOQI stages and AKDN or KDIGO risk categories. The AKDN and KDIGO systems resulted in appropriate reclassification of uncomplicated patients in the lowest risk categories and a more graded independent association with CVD and DR than the NKF's KDOQI classification. However, CVD, but not DR prevalence was higher in the lowest risk categories of the new classifications than in the lowest stages of the NKF's KDOQI, due to the inclusion of subjects with reduced eGFR without albuminuria. CVD prevalence differed also among eGFR and albuminuria categories grouped into AKDN and KDIGO risk category 1 and moderate, respectively, and to a lesser extent into higher risk categories.Conclusions: Though the new systems perform better than the NKF's KDOQI in grading complications and identifying diabetic subjects without complications, they might underestimate CVD burden in patients assigned to lower risk categories and should be tested in large prospective studies.Trial registration: ClinicalTrials.gov; NCT00715481.
AB - Background: The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (NKF's KDOQI) staging system for chronic kidney disease (CKD) is based primarily on estimated GFR (eGFR). This study aimed at assessing whether reclassification of subjects with type 2 diabetes using two recent classifications based on both eGFR and albuminuria, the Alberta Kidney Disease Network (AKDN) and the Kidney Disease: Improving Global Outcomes (KDIGO), provides a better definition of burden from cardiovascular disease (CVD) and diabetic retinopathy (DR) than the NKF's KDOQI classification.Methods: This is a cross-sectional analysis of patients with type 2 diabetes (n = 15,773) from the Renal Insufficiency And Cardiovascular Events Italian Multicenter Study, consecutively visiting 19 Diabetes Clinics throughout Italy in years 2007-2008. Exclusion criteria were dialysis or renal transplantation. CKD was defined based on eGFR, as calculated from serum creatinine by the simplified Modification of Diet in Renal Disease Study equation, and albuminuria, as measured by immunonephelometry or immunoturbidimetry. DR was assessed by dilated fundoscopy. Prevalent CVD, total and by vascular bed, was assessed from medical history by recording previous documented major acute events.Results: Though prevalence of complications increased with increasing CKD severity with all three classifications, it differed significantly between NKF's KDOQI stages and AKDN or KDIGO risk categories. The AKDN and KDIGO systems resulted in appropriate reclassification of uncomplicated patients in the lowest risk categories and a more graded independent association with CVD and DR than the NKF's KDOQI classification. However, CVD, but not DR prevalence was higher in the lowest risk categories of the new classifications than in the lowest stages of the NKF's KDOQI, due to the inclusion of subjects with reduced eGFR without albuminuria. CVD prevalence differed also among eGFR and albuminuria categories grouped into AKDN and KDIGO risk category 1 and moderate, respectively, and to a lesser extent into higher risk categories.Conclusions: Though the new systems perform better than the NKF's KDOQI in grading complications and identifying diabetic subjects without complications, they might underestimate CVD burden in patients assigned to lower risk categories and should be tested in large prospective studies.Trial registration: ClinicalTrials.gov; NCT00715481.
KW - Albuminuria
KW - Cardiovascular disease
KW - Chronic kidney disease
KW - Classification
KW - Diabetic retinopathy
KW - eGFR
UR - http://www.scopus.com/inward/record.url?scp=84899557970&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84899557970&partnerID=8YFLogxK
U2 - 10.1186/1475-2840-13-59
DO - 10.1186/1475-2840-13-59
M3 - Article
C2 - 24624891
AN - SCOPUS:84899557970
VL - 13
JO - Cardiovascular Diabetology
JF - Cardiovascular Diabetology
SN - 1475-2840
IS - 1
M1 - 59
ER -