Effects of retinopathy and chronic kidney disease on long-term mortality in type 2 diabetic inpatients with normal urinary albumin or protein: a retrospective cohort study

ObjectiveNormoalbuminuric chronic kidney disease (NA-CKD) is recognised as a distinct phenotype of diabetic kidney disease, but the role of diabetic retinopathy (DR) in predicting long-term mortality among these patients remains unclear. Here, we aimed to investigate the effects of DR and CKD on mortality in type 2 diabetic patients with normoalbuminuria.DesignWe conducted this study as a retrospective cohort study.SettingWe collected clinical information from the medical records of a public medical centre in central Taiwan.ParticipantsPatients with type 2 diabetes (n=665) who were hospitalised due to poor glucose control were consecutively enrolled and followed for a median of 6.7 years (IQR 4.1‒9.6 years). Patients with either urinary protein excretion >150 mg/day or urine albumin excretion >30 mg/day were excluded.Primary outcome measureAll-cause mortality served as the primary follow-up outcome, and the mortality data were obtained from the national registry in Taiwan.ResultsThe patients with CKD and DR showed the highest mortality rate (log-rank p<0.001). The risks of all-cause mortality (HR 2.263; 95% CI 1.551 to 3.302) and cardiovascular mortality (HR 2.471; 95% CI 1.421 to 4.297) were significantly greater in patients with CKD and DR than in those without CKD or DR, after adjusting for the associated risk factors.ConclusionsDR is an independent predictor for all-cause and cardiovascular mortality in type 2 diabetic inpatients with normoalbuminuria. Moreover, DR with CKD shows the highest risks of all-cause and cardiovascular mortality among these patients. Funduscopy screening can provide additive information on mortality in patients with type 2 diabetes, even among those with NA-CKD.

Download Full-text

378 CUMULATIVE IMPACT OF HYPERTENSION, TYPE 2 DIABETES AND CHRONIC KIDNEY DISEASE ON ALL-CAUSE AND CARDIOVASCULAR MORTALITY

Journal of Hypertension ◽

10.1097/01.hjh.0000420227.30125.8d ◽

2012 ◽

Vol 30 ◽

pp. e111-e112

Author(s):

Yasuharu Tabara ◽

Takashi Ando ◽

Yasuo Ohashi ◽

Akiko Harada ◽

Hideaki Nakagawa ◽

...

Keyword(s):

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Cardiovascular Mortality ◽

Cumulative Impact

Download Full-text

Effect of Bariatric Surgery on Diagnosed Chronic Kidney Disease and Cardiovascular Events in Patients with Insulin-treated Type 2 Diabetes: a Retrospective Cohort Study from a Large UK Primary Care Database

Obesity Surgery ◽

10.1007/s11695-019-04201-y ◽

2020 ◽

Vol 30 (5) ◽

pp. 1685-1695 ◽

Cited By ~ 2

Author(s):

Mohammed Alkharaiji ◽

Uchenna Anyanwagu ◽

Richard Donnelly ◽

Iskandar Idris

Keyword(s):

Type 2 Diabetes ◽

Bariatric Surgery ◽

Primary Care ◽

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Cardiovascular Events ◽

Retrospective Cohort ◽

Care Database

Download Full-text

Long-term quality-of-care score predicts incident chronic kidney disease in patients with type 2 diabetes

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfx375 ◽

2018 ◽

Vol 33 (11) ◽

pp. 2012-2019 ◽

Cited By ~ 1

Author(s):

Pi-I Li ◽

Jian-Nan Wang ◽

How-Ran Guo

Keyword(s):

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

Quality Of Care ◽

Kidney Disease ◽

Incident Chronic Kidney Disease

Download Full-text

Physical activity is associated with decreased incidence of chronic kidney disease in type 2 diabetes patients: A retrospective cohort study in Taiwan

Primary Care Diabetes ◽

10.1016/j.pcd.2014.04.004 ◽

2014 ◽

Vol 8 (4) ◽

pp. 315-321 ◽

Cited By ~ 13

Author(s):

Hsing-Chun Lin ◽

Chiung-Huei Peng ◽

Jeng-Yuan Chiou ◽

Chien-Ning Huang

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Diabetes Patients

Download Full-text

Pros and cons of gastric bypass surgery in individuals with obesity and type 2 diabetes: nationwide, matched, observational cohort study

BMJ Open ◽

10.1136/bmjopen-2018-023882 ◽

2019 ◽

Vol 9 (1) ◽

pp. e023882 ◽

Cited By ~ 10

Author(s):

Vasileios Liakopoulos ◽

Stefan Franzén ◽

Ann-Marie Svensson ◽

Mervete Miftaraj ◽

Johan Ottosson ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Gastric Bypass ◽

Kidney Disease ◽

Secondary Outcome ◽

Control Group ◽

Positive Effects ◽

All Cause Mortality

ObjectivesLong-term effects of gastric bypass (GBP) surgery have been presented in observational and randomised studies, but there are only limited data for persons with obesity and type 2 diabetes mellitus (T2DM) regarding postoperative complications.DesignThis is a nationwide observational study based on two quality registers in Sweden (National Diabetes Register, NDR and Scandinavian Obesity Surgery Register, SOReg) and other national databases.SettingAfter merging the data, we matched individuals with T2DM who had undergone GBP with those not surgically treated for obesity on propensity score, based on sex, age, body mass index (BMI) and calendar time. The risks of postoperative outcomes (rehospitalisations) were assessed using Cox regression models.ParticipantsWe identified 5321 patients with T2DM in the SOReg and 5321 matched controls in the NDR, aged 18–65 years, with BMI >27.5 kg/m² and followed for up to 9 years.Primary and secondary outcome measuresWe assessed risks for all-cause mortality and hospitalisations for cardiovascular disease, severe kidney disease, along with surgical and other medical conditions.ResultsThe results agree with the previously suggested lower risks of all-cause mortality (49%) and cardiovascular disease (34%), and we also found positive effects for severe kidney disease but significantly increased risks (twofold to ninefold) of several short-term complications after GBP, such as abdominal pain and gastrointestinal conditions, frequently requiring surgical procedures, apart from reconstructive plastic surgery. Long-term, the risk of anaemia was 92% higher, malnutrition developed approximately three times as often, psychiatric diagnoses were 33% more frequent and alcohol abuse was three times as great as in the control group.ConclusionsThis nationwide study confirms the benefits and describes the panorama of adverse events after bariatric surgery in persons with obesity and T2DM. Long-term postoperative monitoring and support, as better selection of patients by appropriate specialists in interdisciplinary settings, should be provided to optimise the outcomes.

Download Full-text