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Open Access Highly Accessed Research article

Association of chronic kidney disease (CKD) and failure to monitor renal function with adverse outcomes in people with diabetes: a primary care cohort study

Andrew P McGovern1*, Benjamin Rusholme1, Simon Jones1, Jeremy N van Vlymen1, Harshana Liyanage1, Hugh Gallagher2, Charles RV Tomson3, Kamlesh Khunti1, Kevin Harris4 and Simon de Lusignan1

Author Affiliations

1 Department of Healthcare Management and Policy, University of Surrey, Guildford, UK

2 South West Thames Renal and Transplantation Unit, St Helier Hospital, Carshalton, UK

3 Southmead Hospital, North Bristol NHS Trust, Bristol, UK

4 John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK

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BMC Nephrology 2013, 14:198  doi:10.1186/1471-2369-14-198

Published: 18 September 2013

Abstract

Background

Chronic kidney disease (CKD) is a known risk factor for cardiovascular events and all-cause mortality. We investigate the relationship between CKD stage, proteinuria, hypertension and these adverse outcomes in the people with diabetes. We also study the outcomes of people who did not have monitoring of renal function.

Methods

A cohort of people with type 1 and 2 diabetes (N = 35,502) from the Quality Improvement in Chronic Kidney Disease (QICKD) cluster randomised trial was followed up over 2.5 years. A composite of all-cause mortality, cardiovascular events, and end stage renal failure comprised the outcome measure. A multilevel logistic regression model was used to determine correlates with this outcome. Known cardiovascular and renal risk factors were adjusted for.

Results

Proteinuria and reduced estimated glomerular filtration rate (eGFR) were independently associated with adverse outcomes in people with diabetes. People with an eGFR <60 ml/min, proteinuria, and hypertension have the greatest odds ratio (OR) of adverse outcome; 1.58 (95% CI 1.36-1.83). Renal function was not monitored in 4460 (12.6%) people. Unmonitored renal function was associated with adverse events; OR 1.35 (95% CI 1.13-1.63) in people with hypertension and OR 1.32 (95% CI 1.07-1.64) in those without.

Conclusions

Proteinuria, eGFR < 60 ml/min, and failure to monitor renal function are associated with cardiovascular and renal events and mortality in people with diabetes.

Keywords:
Unmonitored; Primary care; Cardiovascular risk; Proteinuria; Estimated glomerular filtration rate