Diabetic kidney disease phenotypes and the risk of cardiovascular events: The Silesia Diabetes-Heart Project

The impact of diabetic kidney disease (DKD) phenotype on the cardiovascular (CV) risk remains ambiguous. This was a prospective, single-center study (The Silesia Diabetes-Heart Project, NCT05626413) of people with diabetes mellitus (DM). The primary outcome was a composite of CV events during a median follow up of 2.8 years (IQR 1.7; 4.0). Individuals were divided into groups based on DKD phenotypes [reduced estimated glomerular filtration rate (eGFR) (< 60 mL/min/1.73 m2), and/or elevated urinary albumin creatinine ratio (UACR) (≥ 30 mg/g)] and compared to those without DKD. Among 2306 people with DM (mean age 58 ± 18 years, 51.9% males) those with DKD had higher CV events risk (aHR 1.02, 95% CI 1.01–1.03) compared to those without DKD. People with reduced eGFR (aHR 1.78, 95% CI 1.19–2.67) and those with reduced eGFR and elevated UACR (aHR 1.60, 95% CI 1.08–2.37) were at higher risk of CV events compared to people with normal eGFR and UACR, while people with elevated UACR only (aHR 0.91, 95% CI 0.62–1.32) did not had the risk heightened. Among people with DKD less frequent prescriptions with sodium-glucose co-transporter 2 inhibitors and renin–angiotensin–aldosterone system inhibitors were observed (OR 0.38, 95% CI 0.29–0.49, p < 0.001 and OR 0.39, 95% CI 0.30–0.50, p < 0.001, respectively) compared with the ones without DKD. People with DKD, with reduced eGFR or both reduced eGFR and elevated UACR, but not with elevated UACR alone, are at higher CV risk. Personalizing therapy based on clinic-based renal phenotyping can facilitate the initiation of CV disease modifying therapy.