Key result
Prior T2D in incident CKD linked to ~14% higher mortality vs no diabetes or hypertension.
Why the study?
CKD, T2D, and HTN are frequently associated with adverse outcomes, but the impact of prior T2D and/or HTN on clinical characteristics, cardiovascular events, and all-cause mortality in CKD required estimation.
Does a prior diagnosis of T2D and/or HTN increase the risk of cardiovascular events and mortality in patients with incident CKD?
Cohort (n=398,477)
Yes
Does a prior diagnosis of T2D and/or HTN increase the risk of cardiovascular events and mortality in patients with incident CKD?
In patients with incident CKD, a prior diagnosis of T2D alone is associated with the highest risk of all-cause mortality, while the combination of T2D and HTN confers the highest risk for cardiovascular events.
BACKGROUND: Chronic Kidney Disease (CKD), Type 2 Diabetes (T2D) and Hypertension (HTN) are frequently associated with adverse outcomes. We aimed to estimate the impact of a prior diagnosis of T2D and/or HTN on clinical characteristics, cardiovascular events (CVE) and all-cause mortality (ACM) of patients with CKD. METHODS: We conducted a retrospective cohort study based on primary care electronic health records of people without atherosclerotic cardiovascular disease, aged 18-90 years with incident CKD between January 1, 2007, and December 31, 2017. The association between CKD groups classified according to prior diagnosis of T2D and/or HTN and risk of ACM and CVE at follow-up was evaluated with Cox and Fine-Gray regression models, respectively. RESULTS: 398,477 patients were included. Median age was 74 years and 55.2% were women. Individuals were classified as CKD with HTN (51.9%), CKD with T2D (3.87%), CKD with HTN/T2D (31.4%) and CKD without HTN/T2D (12.9%). In the multivariate analysis, with the CKD without HTN/T2D group as reference, the ACM Hazard Ratio (HR) was 0.74 (95%CI 0.72-0.75) for the CKD with HTN group, 0.81 (95%CI 0.79-0.83) for CKD with HTN/T2D and 1.14 (95%CI 1.10-1.19) for the CKD with T2D group. The sub distribution HRs for CVE were 1.40 (95%CI 1.34-1.47), 1.70 (95%CI 1.61-1.80) and 1.37 (95%CI 1.26-1.48), respectively. CONCLUSION: In patients with CKD, the risk of ACM and CVE differed in patients with previous HTN and/or T2D. These comorbidities can help identify individuals at higher risk of adverse outcomes and improve the management of patients with CKD in primary care.
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Cunillera et al. (2022) conducted a cohort in Incident Chronic Kidney Disease (CKD) (n=398,477). Prior diagnosis of Type 2 Diabetes (T2D) vs. CKD without Hypertension or Type 2 Diabetes was evaluated on All-cause mortality (HR 1.14, 95% CI 1.10-1.19, p=<0.001). Prior diagnosis of type 2 diabetes in patients with incident chronic kidney disease increased all-cause mortality risk by 14% (HR 1.14) compared to patients without diabetes or hypertension.
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