The risk trajectory of different cardiovascular morbidities associated with chronic kidney disease among patients with newly diagnosed diabetes mellitus: a propensity score-matched cohort analysis

Cardiovascular Diabetology

Kuo-Liong Chien¹  Jui Wang¹  Szu-Ying Lee²  Kuan-Yu Hung³  Chia-Ter Chao⁴ 

[1] Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University;Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch;Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital;Neprology Division, Department of Internal Medicine, National Taiwan University Hospital BeiHu Branch;

关键词: Cardiovascular disease;    Chronic kidney disease;    Diabetes kidney disease;    Diabetes mellitus;    Microvascular complication;    Myocardial infarction;   

DOI  :  10.1186/s12933-021-01279-6

来源: DOAJ

【 摘 要 】

Abstract Background Chronic kidney disease (CKD) introduces an increased cardiovascular risk among patients with diabetes mellitus (DM). The risk and tempo of cardiovascular diseases may differ depending upon their type. Whether CKD differentially influences the risk of developing each cardiovascular morbidity in patients with newly diagnosed DM remains unexplored. Methods We identified patients with incident DM from the Longitudinal Cohort of Diabetes Patients (LCDP) cohort (n = 429,616), and uncovered those developing CKD after DM and their propensity score-matched counterparts without. After follow-up, we examined the cardiovascular morbidity-free rates of patients with and without CKD after DM, followed by Cox proportional hazard regression analyses. We further evaluated the cumulative risk of developing each outcome consecutively during the study period. Results From LCDP, we identified 55,961 diabetic patients with CKD and matched controls without CKD. After 4.2 years, patients with incident DM and CKD afterward had a significantly higher risk of mortality (hazard ratio [HR] 1.1, 95% confidence interval [CI] 1.06–1.14), heart failure (HF) (HR 1.282, 95% CI 1.19–1.38), acute myocardial infarction (AMI) (HR 1.16, 95% CI 1.04–1.3), and peripheral vascular disease (PVD) (HR 1.277, 95% CI 1.08–1.52) compared to those without CKD. The CKD-associated risk of mortality, HF and AMI became significant soon after DM occurred and remained significant throughout follow-up, while the risk of PVD conferred by CKD did not emerge until 4 years later. The CKD-associated risk of ischemic, hemorrhagic stroke and atrial fibrillation remained insignificant. Conclusions The cardiovascular risk profile among incident DM patients differs depending on disease type. These findings can facilitate the selection of an optimal strategy for early cardiovascular care for newly diagnosed diabetic patients.

【 授权许可】

Unknown