Association between atherosclerotic cardiovascular diseases risk and renal outcome in patients with type 2 diabetes mellitus

Chronic kidney disease (CKD) and diabetes mellitus increase atherosclerotic cardiovascular diseases (ASCVD) risk. However, the association between renal outcome of diabetic kidney disease (DKD) and ASCVD risk is unclear. This retrospective study enrolled 218 type 2 diabetic patients with biopsy-proven DKD, and without known cardiovascular diseases. Baseline characteristics were obtained and the 10-year ASCVD risk score was calculated using the Pooled Cohort Equation (PCE). Renal outcome was defined as progression to end-stage renal disease (ESRD). The association between ASCVD risk and renal function and outcome was analyzed with logistic regression and Cox analysis. Among all patients, the median 10-year ASCVD risk score was 14.1%. The median of ASCVD risk score in CKD stage 1, 2, 3, and 4 was 10.9%, 12.3%, 16.5%, and 14.8%, respectively (<i>p</i> = 0.268). Compared with patients with lower ASCVD risk (＜14.1%), those with higher ASCVD risk had lower eGFR, higher systolic blood pressure, and more severe renal interstitial inflammation. High ASCVD risk (&gt;14.1%) was an independent indicator of renal dysfunction in multivariable-adjusted logistic analysis (OR, 3.997; 95%CI, 1.385–11.530; <i>p</i> = 0.010), though failed to be an independent risk factor for ESRD in patients with DKD in univariate and multivariate Cox analysis. DKD patients even in CKD stage 1 had comparable ASCVD risk score to patients in CKD stage 2, 3, and 4. Higher ASCVD risk indicated severe renal insufficiency, while no prognostic value of ASVCD risk for renal outcome was observed, which implied macroangiopathy and microangiopathy in patients with DKD were related, but relatively independent.

慢性肾脏病（Chronic kidney disease, CKD）与糖尿病均会升高动脉粥样硬化性心血管疾病（atherosclerotic cardiovascular diseases, ASCVD）风险。然而，糖尿病肾病（diabetic kidney disease, DKD）的肾脏结局与ASCVD风险之间的关联尚不明确。本项回顾性研究纳入了218例经活检证实的DKD且无明确心血管疾病病史的2型糖尿病患者。研究收集了患者的基线特征，并使用汇总队列方程（Pooled Cohort Equation, PCE）计算10年ASCVD风险评分。肾脏结局定义为进展至终末期肾病（end-stage renal disease, ESRD）。采用logistic回归与Cox分析，探究ASCVD风险与肾功能及肾脏结局之间的关联。所有入组患者的10年ASCVD风险评分中位数为14.1%。CKD 1、2、3、4期患者的ASCVD风险评分中位数分别为10.9%、12.3%、16.5%与14.8%（<i>p</i> = 0.268）。与ASCVD风险较低（＜14.1%）的患者相比，ASCVD风险较高的患者估算肾小球滤过率（eGFR）更低、收缩压更高，且肾间质炎症程度更严重。多变量校正后的logistic回归分析显示，高ASCVD风险（＞14.1%）是肾功能不全的独立预测指标（优势比，3.997；95%置信区间，1.385~11.530；<i>p</i> = 0.010），但在单因素与多因素Cox分析中，其并未成为DKD患者进展为ESRD的独立危险因素。即使是CKD 1期的DKD患者，其ASCVD风险评分与CKD 2、3、4期患者相当。更高的ASCVD风险提示存在严重肾功能不全，但未观察到ASCVD风险对肾脏结局的预测价值，这表明DKD患者的大血管病变与微血管病变既存在关联，又相对独立。