Patients with non-proteinuric diabetes mellitus and chronic kidney disease are not at greater risk for cardiorenal syndrome compared to patients with CKD and no diabetes, according to a study published in Nephrology Dialysis Transplantation. The presence of diabetes per se, as well as moderate proteinuria, was associated with higher mortality and cardiovascular event risk; but abnormal proteinuria affected the risk of ESRD independent of diabetes.

Diabetes mellitus 

(DM), commonly referred to as diabetes, is a group of metabolic disorders in which there are high blood sugar levels over a prolonged period. Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger. If left untreated, diabetes can cause many complications. Acute complications can include diabetic ketoacidosis, hyperosmolar hyperglycemic state, or death.

Serious long-term complications include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, and damage to the eyes. Diabetes is due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced.

In the absence of proteinuria, [diabetes mellitus with chronic kidney disease] DM-CKD patients are not exposed to increased cardiorenal risk when compared with non-diabetic CKD patients,” Roberto Minutolo, MD, Ph.D., of the division of nephrology at the University of Campania in Italy, and colleagues wrote. “In contrast, in proteinuric CKD patients, the risk of ESRD is primarily driven by the proteinuria level independent of diabetic status.

The independent effect of diabetic status per se only emerges in the presence of moderate proteinuria where diabetes heralds a higher risk of [cardiovascular] CV morbidity and mortality.

Researchers used data gathered from four similar cohort studies that used patient information from 40 Italian nephrology clinics. Each cohort study gathered patient CV disease history; physical exam data on height, body weight and medication profiles; and lab results.

Researchers looked at outcome measures including all-cause death, ESRD, the composite CV endpoint of non-fatal CV events requiring hospitalization and CV death, whichever occurred first, according to the report. Furthermore, researchers noted that the study had only been limited by its predictors at baseline. However, it was determined that follow-ups after patients’ initial visit to the clinic could exclude any substantial changes in their risk factors that would impact study outcomes.