BOSTON - Patients with chronic kidney disease and type 2 diabetes have a higher mortality risk reported the Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease.
According to Marc Pfeffer, MD, PhD, and colleagues, of Brigham and Women's Hospital in Boston, the two dozen randomized controlled trials involving diabetic patients, the highest mortality rates were observed in those trials that required the inclusion of patients with renal disease.
Trials that selected for patients with elevated serum creatinine or impaired estimated glomerular filtration rate (eGFR) had mortality rates of 5.9 to 8.2 per 100 patient-years, whereas the rest of the trials had rates no higher than 3.3, the researchers reported in the online Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease.
"Risk stratification by evidence of kidney disease, determined by renal function or proteinuria, should be emphasized in diabetic subjects, given its major impact on morbidity and mortality," they wrote.
Pfeffer and colleagues examined 22 randomized trials of at least 1,000 patients with type 2 diabetes and a follow-up duration of at least one year, looking for relationships between specific inclusion and exclusion criteria and all-cause mortality. They excluded trials that selected patients with acute coronary syndromes or end-stage renal disease.
The trials included a total of 91,742 patients, of whom 7.5% died.
After intervention and control arms were combined, mortality rates among the trials ranged widely, from 0.28 to 8.24 per 100 patient-years.
Six trials had a mortality rate of less than 1 per 100 patient-years, 10 had a rate of 1 to less than 2, and three each had rates of 2 to less than 4 and 4 to less than 10.