Chronic Kidney Disease, Diabetes, and risk of mortality afte
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The aim of this study was to assess the long-term prognostic significance of both diabetes and renal impairment in two prospective nationwide cohorts of AMI patients: FAST-MI (French Registry of Acute ST-Elevation or non-ST-elevation Myocardial Infarction) 2005 and FAST-MI 2010 (n = 4,169). Both registries consecutively included patients with AMI admitted to cardiac intensive care units within 48 h of symptom onset during a specified 1-month period. AMI was defined by increased levels of cardiac biomarkers together with either compatible symptoms or electrocardiogram changes. Vital status at 5 years was available in >95%.

We assessed all-cause mortality at 5 years according to estimated GFR (eGFR) (calculated with Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] formula and based on KDIGO [Kidney Disease: Improving Global Outcomes] GFR categories with eGFR <30 and <15 mL/min/1.73 square metre pooled) and diabetes status at inclusion. Multivariable proportional hazards models (assumptions checked) were used with covariates chosen based on their potential prognostic relevance: year of inclusion; sex; age; BMI categories; hypertension; current smoking; prior AMI; peripheral artery disease; history of heart failure, stroke, cancer, and chronic obstructive pulmonary disease; type of myocardial infarction (MI) (STEMI or NSTEMI); GRACE risk score; percutaneous coronary intervention or coronary artery bypass during hospitalization; and left ventricular ejection fraction.

Stratified analysis showed that increasing renal impairment was associated with an increased risk of death for participants with diabetes under a threshold of 60 mL/min/1.73 square metre but only below a threshold of 45 mL/min/1.73 square metre for participants without diabetes. Compared with no diabetes, diabetes was associated with an increased risk of 5-year death throughout eGFR categories, except for eGFR <30 mL/min/1.73 square metre.

These results suggest that in post-MI patients, 1) chronically impaired renal failure and diabetes are both associated with an increased risk of mortality, 2) renal function requires specific attention in patients with diabetes as soon as it is mildly impaired, and 3) tight glycemic control, which is controversial in post-MI patients, may not be essential in patients with diabetes with eGFR <30 mL/min/1.73 square metre.

Source: https://care.diabetesjournals.org/content/43/3/e43
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