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Kidney Week

Abstract: FR-PO279

Association of Pre-Diabetes with CKD Progression and Adverse Cardiovascular Outcomes in Patients with CKD in the Chronic Renal Insufficiency Cohort (CRIC) Study

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Correa, Simon, Brigham and Women''s Hospital, Boston, Massachusetts, United States
  • Neves, João Sérgio, São João Hospital, Porto, Portugal
  • Baeta Baptista, Rute, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
  • Bigotte Vieira, Miguel, Centro Hospitalar Lisboa Norte, Lisbon, Lisbon, Portugal
  • Waikar, Sushrut S., Brigham and Women''s Hospital, Boston, Massachusetts, United States
  • McCausland, Finnian R., Brigham and Women''s Hospital, Boston, Massachusetts, United States
Background

Despite our understanding of diabetes (DM) as an established risk factor for renal and cardiac complications in CKD, the prognostic significance of prediabetes in this population remains largely unknown. We aimed to evaluate the association of prediabetes with CKD progression, adverse cardiovascular events and all-cause mortality in patients with CKD.

Methods

Participants of the Chronic Renal Insufficiency Cohort (CRIC) were categorized as having normoglycemia, prediabetes or DM according to fasting plasma glucose, HbA1c and treatment with anti-diabetic drugs at baseline. Adjusted Cox proportional hazards models (clinical variables, eGFR, 24-h urine protein, hematocrit and serum albumin) were fit to estimate the association of prediabetes and DM (versus normoglycemia) with CKD progression (development of ESRD or 50% decline in eGFR to ≤15 ml/min/1.73 m2), a composite cardiovascular outcome (congestive heart failure, myocardial infarction or stroke) and all-cause mortality.

Results

Of the 3,701 individuals analyzed, 945 were classified as normoglycemic, 847 had prediabetes and 1909 had DM. Median follow-up was 7.5 years. While prediabetes was not associated with the risk of CKD progression (HRadj 0.96, 95% CI 0.76-1.21), it was associated with a 39% higher risk of the composite cardiovascular outcome (HRadj 1.39, 95% CI 1.06-1.83) (Figure 1) and a trend towards an increased risk of all-cause mortality (HRadj 1.28, 95% CI 0.99-1.67). Patients with DM had an increased risk of CKD progression (HRadj 1.38, 95% CI 1.12-1.70), composite cardiovascular outcome (HRadj 1.65, 95% CI 1.28-2.13) and all-cause mortality (HRadj 1.55, 95% CI 1.21-1.97).

Conclusion

In patient with CKD, prediabetes was not associated with CKD progression but was associated with an increased risk of adverse cardiovascular outcomes.

Kaplan-Meier curves for chronic kidney disease progression (A), composite cardiovascular outcome (B) and all-cause mortality (C) in participants with normoglycemia, prediabetes or diabetes.