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

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, Diederick E Grobbee

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)1068-1075
Number of pages8
JournalThe American Journal of Medicine
Volume130
Issue number9
DOIs
Publication statusPublished - Sept 2017

Keywords

  • 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
  • Multicenter Study
  • Oxazoles
  • Patient Discharge
  • Percutaneous Coronary Intervention
  • Peroxisome Proliferator-Activated Receptors
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Randomized Controlled Trial
  • Renal Insufficiency, Chronic
  • Risk Factors
  • Thiophenes

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