Nefropatía diabética y riesgo cardiovascular

ResumenLa importancia de la detección precoz de la nefropatía diabética radica en que es un marcador de riesgo cardiovascular y nos indica la existencia de una alteración vascular que se asocia a un aumento del riesgo de padecer un evento cardiovascular, tanto en la diabetes Mellitus tipo 1 (DM 1) como en la tipo 2 (DM 2).La microalbuminuria es un factor de riesgo para la mortalidad total, cardiovascular y coronaria, en los pacientes con DM 1.La mortalidad total se encuentra aumentada en pacientes con DM 2 y microalbúmina, con un RR del 1.8 y se relaciona con niveles de microalbúmina incluso por debajo del rango considerado como normal (20μg/minuto y/o 30mg/día). Por ello, la definición de microalbúmina debe ser revisada en los pacientes con DM 2.Se necesitan más trabajos que confirmen el poder predictivo de la microalbuminuria sobre la enfermedad cardiovascular y coronaria.AbstractThe importance of the early detection of diabetic nephropathy is because it is a cardiovascular risk marker and it indicates the existence of vascular changes associated to an increase risk of having a cardiovascular event in diabetes mellitus type 1 (DM 1), as well as in type 2 (DM 2).Microalbuminuria is a risk factor for overall cardiovascular and coronary mortality in the patients with DM 1.Total mortality is increased in patients with DM 2 and microalbuminuria with a RR of 1.8, and it is related to microalbuminuria levels even below the considered normal range (20μg/min and/or 30mg/day). For this reason, the definition of microalbuminuria must be reviewed in the patients with DM 2.More studies are needed to confirm the predictive power of microalbuminuria in cardiovascular and coronary disease

Enfermedad renal crónica en España: prevalencia y factores relacionados en personas con diabetes mellitus mayores de 64 años

Resumen: Introducción: La diabetes mellitus tipo 2 y la enfermedad renal crónica (ERC) son afecciones de elevada prevalencia en personas ≥ 65 años y constituyen un importante problema de salud pública. Objetivos: Conocer la prevalencia de la ERC, sus categorías y su relación con diversos factores demográficos y clínicos, en pacientes ancianos con diabetes mellitus tipo 2 en España. Métodos: Estudio epidemiológico, observacional, transversal, multicéntrico, ámbito nacional. Se incluyeron pacientes con diabetes mellitus tipo 2 conocida, edad ≥ 65 años atendidos en Atención Primaria. Se recogieron variables demográficas, antropométricas y analíticas de los últimos 12 meses, incluyendo el cociente albúmina-creatinina y el filtrado glomerular estimado para evaluar la función renal. Resultados: La prevalencia de ERC fue del 37,2% (IC95%, 34,1-40,3%), de insuficiencia renal del 29,7% (IC95%, 26,8-32,6%) y de elevación de la albuminuria del 20,6% (IC95%, 17,3-23,9%), moderadamente elevada 17,8% (IC95%, 14,7-20,9%), severamente elevada 2,8% (IC95%, 1,4-4,2%). La prevalencia de las categorías de ERC fueron: G1 1,3% (IC95%, 0,6-2%), G2 6,2% (IC95%, 4,6-7,8%), G3a 17,2% (IC95%, 14,8-19,6%), G3b 9,8% (IC95%, 7,9-11,7%), G4 2% (IC95%, 1,1-2,9%) y G5 0,7% (IC95%, 0,2-1,2%).En el análisis multivariante, después de ajustar por el resto de variables, la ERC se asoció a mayor edad OR 5,13, (IC95%, 3,15-8,35), alta comorbilidad OR 3,36 (IC95%, 2,2-5,12) y la presencia de tratamiento antihipertensivo OR 2,43 (IC95%, 1,48-4,02). Conclusiones: La ERC es frecuente en la población diabética ≥ 65 años y se asocia con mayor edad, alta comorbilidad e hipertensión tratada. No se ha encontrado asociación con el género y años de evolución de la diabetes. Abstract: Introduction: Type 2 diabetes mellitus and chronic kidney disease (CKD) are conditions which have a high prevalence in individuals ≥ 65 years of age and represent a major public health problem. Objectives: To determine the prevalence of CKD, its categories and its relationship with various demographic and clinical factors in elderly patients with type 2 diabetes mellitus in Spain. Methods: Observational, cross-sectional, multicenter, Spanish epidemiological study. Patients with known type 2 diabetes mellitus, age ≥ 65 years of age treated in Primary Care were included. We collected demographic, anthropometric and analytical variables from the previous 12 months, including the albumin-to-creatinine ratio and estimated glomerular filtration rate to evaluate renal function. Results: The prevalence of CKD was 37.2% (95% CI, 34.1–40.3%), renal failure was 29.7% (95% CI, 26.8–32.6%) and increased albuminuria was 20.6% (95% CI, 17.3–23.9%), moderately increased albuminuria was 17.8% (95% CI, 14.7–20.9%) and severely increased albuminuria was 2.8% (95% CI, 1.4–4.2%). In turn, the prevalence of CKD categories were: G1 1.3% (95% CI, 0.6–2%), G2 6.2% (95% CI, 4.6–7.8%), G3a 17.2% (95% CI, 14.8–19.6%), G3b 9.8% (95% CI, 7.9–11.7%), G4 2% (95% CI, 1.1–2.9%) and G5 0.7% (95% CI, 0.2–1.2%).In the multivariate analysis, after adjusting for the remaining variables, CKD was associated with elderly age (OR 5.13, 95% CI, 3.15–8.35), high comorbidity (OR 3.36. 95% CI, 2.2–5.12) and presence of antihypertensive treatment (OR 2.43. 95% CI, 1.48–4.02). Conclusions: CKD is frequent in the diabetic population ≥ 65 years of age and is associated with elderly age, high comorbidity and with treated hypertension. No relationship has been found with gender and time in years since onset of diabetes. Palabras clave: Enfermedad renal crónica, Categorías, ancianos, Dependencia, Comorbilidad, Diabetes mellitus tipo 2, Keywords: Chronic kidney disease, Categories, elderly, Dependence, Comorbidity, Type 2 diabetes mellitu

Diabetes Does Not Increase the Risk of Hospitalization Due to COVID-19 in Patients Aged 50 Years or Older in Primary Care-APHOSDIAB-COVID-19 Multicenter Study.

The purpose of this study was to identify clinical, analytical, and sociodemographic variables associated with the need for hospital admission in people over 50 years infected with SARS-CoV-2 and to assess whether diabetes mellitus conditions the risk of hospitalization. A multicenter case-control study analyzing electronic medical records in patients with COVID-19 from 1 March 2020 to 30 April 2021 was conducted. We included 790 patients: 295 cases admitted to the hospital and 495 controls. Under half (n = 386, 48.8%) were women, and 8.5% were active smokers. The main comorbidities were hypertension (50.5%), dyslipidemia, obesity, and diabetes (37.5%). Multivariable logistic regression showed that hospital admission was associated with age above 65 years (OR from 2.45 to 3.89, ascending with age group); male sex (OR 2.15, 95% CI 1.47-3.15), fever (OR 4.31, 95% CI 2.87-6.47), cough (OR 1.89, 95% CI 1.28-2.80), asthenia/malaise (OR 2.04, 95% CI 1.38-3.03), dyspnea (4.69, 95% CI 3.00-7.33), confusion (OR 8.87, 95% CI 1.68-46.78), and a history of hypertension (OR 1.61, 95% CI 1.08-2.41) or immunosuppression (OR 4.97, 95% CI 1.45-17.09). Diabetes was not associated with increased risk of hospital admission (OR 1.18, 95% CI 0.80-1.72; p = 0.38). Diabetes did not increase the risk of hospital admission in people over 50 years old, but advanced age, male sex, fever, cough, asthenia, dyspnea/confusion, and hypertension or immunosuppression did