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

Giuseppe Pugliese, Anna Solini, Enzo Bonora, Emanuela Orsi, Gianpaolo Zerbini, Cecilia Fondelli, Gabriella Gruden, Franco Cavalot, Olga Lamacchia, Roberto Trevisan, Monica Vedovato, Giuseppe Penno, Luigi Laviola, Antonio Nicolucci, Salvatore De Cosmo, Susanna Morano, Francesco Pugliese, Laura Salvi, Lucilla Bollanti, Alessandra BazuroPaolo Cavallo-Perin, Bartolomeo Lorenzati, Mariella Trovati, Giovanni Anfossi, Massimo Chirio, Valentina Martina, Silvia Maestroni, Laura Montefusco, Dario Zimbalatti, Antonio Pontiroli, Annamaria Veronelli, Barbara Zecchini, Maura Arosio, Alessia Dolci, Anna Corsi, Giacomo Zoppini, Angelo Avogaro, Elisa Pagnin, Laura Pucci, Daniela Lucchesi, Eleonora Russo, Monia Garofolo, Francesco Dotta, Laura Nigi, Alessandra Gatti, Raffaella Buzzetti, Chiara Foffi, Mauro Cignarelli, Sabina Pinnelli, Lucia Monaco, Francesco Giorgino, Sebastio Perrini, Giorgio Sesti, Francesco Andreozzi, Marco Giorgio Baroni, Giuseppina Frau

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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 languageEnglish
Article number59
JournalCardiovascular Diabetology
Volume13
Issue number1
DOIs
Publication statusPublished - Mar 13 2014

Fingerprint

Kidney Diseases
Chronic Renal Insufficiency
Type 2 Diabetes Mellitus
Multicenter Studies
Renal Insufficiency
Cardiovascular Diseases
Cross-Sectional Studies
Alberta
Albuminuria
Kidney
Diabetic Retinopathy
Diet Therapy
Diabetes Complications
Kidney Transplantation
Italy
Blood Vessels
Dialysis
Creatinine

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 journalArticle

Pugliese, G, Solini, A, Bonora, E, Orsi, E, Zerbini, G, Fondelli, C, Gruden, G, Cavalot, F, Lamacchia, O, Trevisan, R, Vedovato, M, Penno, G, Laviola, L, Nicolucci, A, Cosmo, SD, Morano, S, Pugliese, F, Salvi, L, Bollanti, L, Bazuro, A, Cavallo-Perin, P, Lorenzati, B, Trovati, M, Anfossi, G, Chirio, M, Martina, V, Maestroni, S, Montefusco, L, Zimbalatti, D, Pontiroli, A, Veronelli, A, Zecchini, B, Arosio, M, Dolci, A, Corsi, A, Zoppini, G, Avogaro, A, Pagnin, E, Pucci, L, Lucchesi, D, Russo, E, Garofolo, M, Dotta, F, Nigi, L, Gatti, A, Buzzetti, R, Foffi, C, Cignarelli, M, Pinnelli, S, Monaco, L, Giorgino, F, Perrini, S, Sesti, G, Andreozzi, F, Baroni, MG & Frau, G 2014, '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', Cardiovascular Diabetology, vol. 13, no. 1, 59. https://doi.org/10.1186/1475-2840-13-59
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. / 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. In: Cardiovascular Diabetology. 2014 ; Vol. 13, No. 1.
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title = "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",
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.",
keywords = "Albuminuria, Cardiovascular disease, Chronic kidney disease, Classification, Diabetic retinopathy, eGFR",
author = "Giuseppe Pugliese and Anna Solini and Enzo Bonora and Emanuela Orsi and Gianpaolo Zerbini and Cecilia Fondelli and Gabriella Gruden and Franco Cavalot and Olga Lamacchia and Roberto Trevisan and Monica Vedovato and Giuseppe Penno and Luigi Laviola and Antonio Nicolucci and Cosmo, {Salvatore De} and Susanna Morano and Francesco Pugliese and Laura Salvi and Lucilla Bollanti and Alessandra Bazuro and Paolo Cavallo-Perin and Bartolomeo Lorenzati and Mariella Trovati and Giovanni Anfossi and Massimo Chirio and Valentina Martina and Silvia Maestroni and Laura Montefusco and Dario Zimbalatti and Antonio Pontiroli and Annamaria Veronelli and Barbara Zecchini and Maura Arosio and Alessia Dolci and Anna Corsi and Giacomo Zoppini and Angelo Avogaro and Elisa Pagnin and Laura Pucci and Daniela Lucchesi and Eleonora Russo and Monia Garofolo and Francesco Dotta and Laura Nigi and Alessandra Gatti and Raffaella Buzzetti and Chiara Foffi and Mauro Cignarelli and Sabina Pinnelli and Lucia Monaco and Francesco Giorgino and Sebastio Perrini and Giorgio Sesti and Francesco Andreozzi and Baroni, {Marco Giorgio} and Giuseppina Frau",
year = "2014",
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day = "13",
doi = "10.1186/1475-2840-13-59",
language = "English",
volume = "13",
journal = "Cardiovascular Diabetology",
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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

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