부산대학교 도서관

Aim: The risk of cardiorenal events remains high among patients with diabetes and chronic kidney disease (CKD), despite the prescription of recommended treatments. We aimed to determine whether the attainment of a combination of nephroprotection targets at baseline (glycated haemoglobin <7.0%, urinary albumin‐creatinine ratio <300 mg/g, blood pressure <130/80 mmHg, renin‐angiotensin system inhibition) was associated with better cardiorenal outcomes and lower mortality. Materials and Methods: From the prospective French CKD‐REIN cohort, we studied 1260 patients with diabetes and CKD stages 3‐4 (estimated glomerular filtration rate: 15‐60 ml/min/1.73 m2); 69% were men, and at inclusion, mean ± SD age: 70 ± 10 years; estimated glomerular filtration rate: 33 ± 11 ml/min/1.73 m2. The median follow‐up was 4.9 years. Results: In adjusted Cox regression models, the attainment of two nephroprotection targets was consistently associated with a lower risk of cardiorenal events [hazard ratio 0.70 (95% confidence interval 0.57‐0.85)], incident kidney failure with replacement therapy [0.58 (0.43‐0.77)], four major adverse cardiovascular events (cardiovascular death, myocardial infarction, stroke, hospitalization for heart failure) [0.75 (0.57‐0.99)] and all‐cause mortality [0.59 (0.42‐0.82)] when compared with the attainment of zero or one target. For patients with a urinary albumin‐creatinine ratio ≥300 mg/g, those who attained at least two targets had lower hazard ratios for cardiorenal events [0.61 (0.39‐0.96)], four major adverse cardiovascular events [0.53 (0.28‐0.98)] and all‐cause mortality [0.35 (0.17‐0.70)] compared with those who failed to attain any targets. Conclusions: These findings suggest that the attainment of a combination of nephroprotection targets is associated with better cardiorenal outcomes and a lower mortality rate in people with diabetic kidney disease. [ABSTRACT FROM AUTHOR]