The number of nephroprotection targets attained is associated with cardiorenal outcomes and mortality in patients with diabetic kidney disease. The CKD‐REIN cohort study

Aim The risk of cardiorenal events remains high among patients with diabetes and chronic kidney disease (CKD), despite the prescription of recommended treatments. We aimed to determine whether the attainment of a combination of nephroprotection targets at baseline (glycated haemoglobin <7.0%, urinary albumin‐creatinine ratio <300 mg/g, blood pressure <130/80 mmHg, renin‐angiotensin system inhibition) was associated with better cardiorenal outcomes and lower mortality. Materials and Methods From the prospective French CKD‐REIN cohort, we studied 1260 patients with diabetes and CKD stages 3‐4 (estimated glomerular filtration rate: 15‐60 ml/min/1.73 m 2 ); 69% were men, and at inclusion, mean ± SD age: 70 ± 10 years; estimated glomerular filtration rate: 33 ± 11 ml/min/1.73 m 2 . The median follow‐up was 4.9 years. Results In adjusted Cox regression models, the attainment of two nephroprotection targets was consistently associated with a lower risk of cardiorenal events [hazard ratio 0.70 (95% confidence interval 0.57‐0.85)], incident kidney failure with replacement therapy [0.58 (0.43‐0.77)], four major adverse cardiovascular events (cardiovascular death, myocardial infarction, stroke, hospitalization for heart failure) [0.75 (0.57‐0.99)] and all‐cause mortality [0.59 (0.42‐0.82)] when compared with the attainment of zero or one target. For patients with a urinary albumin‐creatinine ratio ≥300 mg/g, those who attained at least two targets had lower hazard ratios for cardiorenal events [0.61 (0.39‐0.96)], four major adverse cardiovascular events [0.53 (0.28‐0.98)] and all‐cause mortality [0.35 (0.17‐0.70)] compared with those who failed to attain any targets. Conclusions These findings suggest that the attainment of a combination of nephroprotection targets is associated with better cardiorenal outcomes and a lower mortality rate in people with diabetic kidney disease.