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Post-Discharge Worsening Renal Function in Patients with Type 2 Diabetes and Recent Acute Coronary Syndrome

By Nuccia Morici, Stefano Savonitto, Claudio Ponticelli, Ilse C Schrieks, Anna Nozza, Francesco Cosentino, Barbara E Stähli, Pasquale Perrone Filardi, Gregory G. Schwartz, Linda Mellbin, A. Michael Lincoff, Jean-Claude Tardif and Diederick E Grobbee


BACKGROUND: Worsening renal function during hospitalization for an acute coronary syndrome is strongly predictive of in-hospital and long-term outcome. However, the role of post-discharge worsening renal function has never been investigated in this setting. METHODS: We considered the placebo cohort of the AleCardio trial comparing aleglitazar with standard medical therapy among patients with type 2 diabetes mellitus and a recent acute coronary syndrome. Patients who had died or had been admitted to hospital for heart failure before the 6-month follow-up, as well as patients without complete renal function data, were excluded, leaving 2776 patients for the analysis. Worsening renal function was defined as a >20% reduction in estimated glomerular filtration rate from discharge to 6 months, or progression to macroalbuminuria. The Cox regression analysis was used to determine the prognostic impact of 6-month renal deterioration on the composite of all-cause death and hospitalization for heart failure. RESULTS: Worsening renal function occurred in 204 patients (7.34%). At a median follow-up of 2 years the estimated rates of death and hospitalization for heart failure per 100 person-years were 3.45 (95% confidence interval [CI], 2.46-6.36) for those with worsening renal function, versus 1.43 (95% CI, 1.14-1.79) for patients with stable renal function. At the adjusted analysis worsening renal function was associated with the composite endpoint (hazard ratio 2.65; 95% CI, 1.57-4.49; P <.001). CONCLUSIONS: Post-discharge worsening renal function is not infrequent among patients with type 2 diabetes and acute coronary syndromes with normal or mildly depressed renal function, and is a strong predictor of adverse cardiovascular events

Topics: Acute Coronary Syndrome, Aged, Albuminuria, Analysis of Variance, Biomarkers, Cause of Death, Comorbidity, Creatinine, Diabetes Complications, Diabetes Mellitus, Type 2, Disease Progression, Female, Follow-Up Studies, Glomerular Filtration Rate, Heart Failure, Humans, Male, Oxazoles, Patient Discharge, Percutaneous Coronary Intervention, Peroxisome Proliferator-Activated Receptors, Predictive Value of Tests, Proportional Hazards Models, Renal Insufficiency, Chronic, Risk Factors, Thiophenes, Multicenter Study, Randomized Controlled Trial
Year: 2017
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Provided by: NARCIS
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