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Abstract
Background
Doubling of serum creatinine is often used as a marker for worsening kidney function in nephrology trials. Most people with chronic kidney disease die of other causes before reaching end-stage renal disease. We were interested in the association between doubling of serum creatinine and the risk of a first-time diagnosis of angina pectoris, congestive heart failure (CHF), myocardial infarction (MI), stroke, or transient ischemic attack in patients with chronic kidney disease and with diagnosed type 2 diabetes mellitus.
Methods
We identified all adult patients registered in the “Clinical Practice Research Datalink” between 2002 and 2011 with incident chronic kidney disease and type 2 diabetes mellitus and did a cohort study with a Cox proportional hazard analysis.
Results
We identified in total 27,811 patients, 693 developed angina pectoris, 1,069 CHF, 508 MI, 970 stroke, and 578 transient ischemic attacks. Patients whose serum creatinine doubled during follow-up had increased risks of CHF (hazard ratio [HR] 2.98, 95% confidence interval [CI] 2.27–3.89), MI (HR 2.53, 95% CI 1.62–3.96), and stroke (HR 1.93, 95% CI 1.38–2.69), as compared with patients whose serum creatinine did not double. The relative risks of angina pectoris (HR 1.18, 95% CI 0.66–2.10) or a transient ischemic attack (HR 1.32, 95% CI 0.78–2.22) were similar in both groups.
Conclusion
Diabetic patients with a doubling of serum creatinine were at an increased risk of CHF, MI, or stroke, compared with diabetic patients whose serum creatinine did not double during follow-up.
Acknowledgments
The study was funded by an unconditional grant from AbbVie, North Chicago, IL, USA. Technical support and programming: Pascal Egger (Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland). The sponsor participated in the design of the study, interpretation of the data, review, and approval of the manuscript.
Author contributions
CS, BC, SSJ, CRM, study concept and design and acquisition, analysis, or interpretation of data; CS, drafting of the manuscript; BC, SSJ, CRM, critical revision of the manuscript for important intellectual content; CS, CRM, statistical analysis; CS, administrative, technical, or material support; CRM, obtained funding and study supervision. All authors contributed toward data analysis, drafting and critically revising the paper and agree to be accountable for all aspects of the work.
Disclosure
BC is employed by AbbVie. The authors report no other conflicts of interest in this work.