Diabetic kidney disease and risk of incident stroke among adults with type 2 diabetes

Arnaud D Kaze; Bernard G Jaar; Gregg C Fonarow; Justin B Echouffo-Tcheugui

doi:10.1186/s12916-022-02317-0

Diabetic kidney disease and risk of incident stroke among adults with type 2 diabetes

BMC Med. 2022 Mar 29;20(1):127. doi: 10.1186/s12916-022-02317-0.

Authors

Arnaud D Kaze¹, Bernard G Jaar^{2

3

4

5}, Gregg C Fonarow⁶, Justin B Echouffo-Tcheugui^{7

8}

Affiliations

¹ Department of Medicine, SOVAH Health, Danville, VA, USA.
² Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
³ Welch Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
⁴ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁵ Nephrology Center of Maryland, Baltimore, USA.
⁶ Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
⁷ Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. jechouf1@jhmi.edu.
⁸ Welch Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA. jechouf1@jhmi.edu.

Abstract

Background: Data on the relations between kidney function abnormalities and stroke in type 2 diabetes are limited. We evaluated the associations of kidney function abnormalities and chronic kidney disease (CKD) stages with incident stroke in a large sample of adults with type 2 diabetes.

Methods: Participants with type 2 diabetes from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study without history of stroke at baseline were included. Urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) were assessed at baseline. CKD categories were defined according to the KDIGO (Kidney Disease: Improving Global Outcomes) guidelines. Cox proportional hazards regression models were used to compute hazard ratios (HR) and 95% confidence intervals (CI) for stroke in relation to measures of kidney function and CKD categories.

Results: A total of 9170 participants (mean age 62.8 [SD: 6.6] years, 38.2% women, 62.9% white) were included. Over a median follow-up of 4.9 years (interquartile range: 4.0-5.7), 156 participants developed a stroke (incidence rate 3.6/1000 person-years [95% CI 3.0-4.2]). After adjusting for relevant confounders, higher UACR and lower eGFR were each associated with increased risk of stroke. Compared to UACR < 30 mg/g, moderate albuminuria and severe albuminuria were associated with increasing hazards for stroke (HR 1.61 [95% CI 1.12-2.32] and 2.29 [95% CI 1.39-3.80], respectively). Compared to eGFR of ≥ 60 mL/min/1.73 m², decreased eGFR (eGFR < 60 mL/min/1.73 m²) was associated with higher risk of stroke (HR 1.50, 95% CI 0.98-2.29). Compared to no CKD, worsening CKD stage was associated with an increasing risk of stroke (HRs of 1.76 [95% CI 1.10-2.83] for CKD G1, 1.77 [95% CI 1.13-2.75] for CKD G2, and 2.03 [95% CI 1.27-3.24] for CKD G3).

Conclusions: In a large sample of adults with type 2 diabetes, increasing albuminuria and worsening stages of early CKD were independently associated with higher risk of incident stroke.

Trial registration: ClinicalTrials.gov. Identifier: NCT00000620 .

Keywords: Albuminuria; Diabetic kidney disease; Epidemiology; Glomerular filtration rate; Stroke; Type 2 diabetes.

Publication types

Clinical Study
Research Support, N.I.H., Extramural

MeSH terms

Albuminuria / complications
Albuminuria / epidemiology
Diabetes Mellitus, Type 2* / complications
Diabetes Mellitus, Type 2* / epidemiology
Diabetic Nephropathies*
Female
Glomerular Filtration Rate
Humans
Male
Middle Aged
Stroke* / complications
Stroke* / epidemiology

Associated data

ClinicalTrials.gov/NCT00000620

Grants and funding

K23 HL153774/HL/NHLBI NIH HHS/United States