Renal damage in patients with Type 2 diabetes: a strong predictor of mortality
Article first published online: 5 NOV 2004
Volume 22, Issue 3, pages 258–265, March 2005
How to Cite
Bo, S., Ciccone, G., Rosato, R., Gancia, R., Grassi, G., Merletti, F. and Pagano, G. F. (2005), Renal damage in patients with Type 2 diabetes: a strong predictor of mortality. Diabetic Medicine, 22: 258–265. doi: 10.1111/j.1464-5491.2004.01394.x
- Issue published online: 16 FEB 2005
- Article first published online: 5 NOV 2004
- Accepted 1 March 2004
- coronary artery disease;
- renal damage;
- Type 2 diabetes
Aims (i) To compare mortality rates in a cohort of Type 2 diabetic patients with those of the general population; (ii) to assess the prognostic role of pre-existing chronic conditions; (iii) to evaluate the impact of different severity of renal damage on mortality.
Methods All 3892 patients with Type 2 diabetes attending our Diabetic Clinic during 1995 and alive on 1 January 1996 were identified and followed for 4.5 years. Information on vital status (100% complete) and causes of death (98.5% complete) for 599 deceased subjects was derived from death certificates.
Results In comparison with the general population, standardized mortality ratios (× 100) were: 125 (95% confidence interval 104–148) in patients aged < 75 and 85 (75–95) in patients ≥ 75 years. Cardiovascular diseases and diabetes were responsible for most of the excess deaths. In a Cox-proportional hazard model, renal damage was a powerful predictor of death (hazard ratio = 2.39; 95% confidence intervals = 2.00–2.85). The severity of renal damage was associated with increasing hazard ratios for death from all-cause mortality and from specific causes (especially coronary artery disease, other cardiovascular causes and diabetes) after multiple adjustments. Other significant predictors of death were: greater age, glycated haemoglobin, smoking, lower body mass index, pre-existing coronary and peripheral artery disease and known co-morbidity (cirrhosis and cancer).
Conclusions Renal damage of any severity is significantly associated with subsequent mortality from all causes and from cardiovascular diseases. These associations are not confounded by pre-existing co-morbidity or coronary diseases.