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Interactive effect of retinopathy and macroalbuminuria on all‐cause mortality, cardiovascular and renal end points in Chinese patients with Type 2 diabetes mellitus
Author(s) -
Tong P. C. Y.,
Kong A. P.,
So W Y.,
Yang X.,
Ng M C. Y.,
Ho C S.,
Ma R C. W.,
Ozaki R.,
Ng V.,
Chow C C.,
Lam C W. K.,
Chan J C. N.,
Cockram C S.
Publication year - 2007
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2007.02145.x
Subject(s) - medicine , albuminuria , microalbuminuria , retinopathy , diabetes mellitus , diabetic retinopathy , myocardial infarction , stroke (engine) , hazard ratio , renal function , nephropathy , cardiology , type 2 diabetes , endocrinology , mechanical engineering , confidence interval , engineering
Aims To examine the effect of albuminuria and retinopathy on the risk of cardiovascular and renal events, and all‐cause mortality in patients with Type 2 diabetes. Methods A post‐hoc analysis of 4416 Chinese patients without macrovascular complications at baseline (age 57.6 ± 13.3 years). Glomerular filtration rate (eGFR) was estimated by the abbreviated Modification of Diet in Renal Disease Study Group Formula, further adjusted for Chinese ethnicity. Clinical end points were all‐cause mortality, cardiovascular events (heart failure or angina, myocardial infarction, lower limb amputation, re‐vascularization procedures and stroke) and renal end points (reduction in eGFR by more than 50% or eGFR < 15 ml/min/1.73 m 2 or death as a result of renal causes or need for dialysis). Results Compared with individuals without complications, subjects with retinopathy and macroalbuminuria had higher rates of cardiovascular events (14.1 vs. 2.4%), renal events (40.0 vs. 0.8%) and death (9.3 vs. 1.7%, P < 0.001). For composite event of death, cardiovascular and renal events, the presence of retinopathy, microalbuminuria alone, macroalbuminuria alone, retinopathy with microalbuminuria or retinopathy with macroalbuminuria increased the risk [hazard ratio (95% CI)] by 1.61 (1.05 to 2.47; P = 0.04), 1.93 (1.38 to 2.69; P < 0.001), 4.34 (3.02 to 6.22; P < 0.001), 2.59 [1.76 to 3.81; P < 0.001) and 6.83 (4.89 to 9.55; P < 0.001) fold, respectively. The relative excess risk as a result of interaction between retinopathy and macroalbuminuria was 15.31, implying biological interaction in the development of renal events. Conclusions In Chinese patients with Type 2 diabetes, retinopathy interacts with macroalbuminuria to increase the risk of composite cardio‐renal events.