Chronic Kidney Disease Predicts Adverse Major Cardiovascular Events and Adverse Limb Events in Patients With Diabetes and Peripheral Arterial Disease

Abstract

This study aims to explore the effect in each stage of chronic kidney disease (CKD) on the major adverse cardiovascular events (MACE) in diabetes mellitus (DM) patients with peripheral arterial disease (PAD). A total of 246 DM patients with diagnosed PAD were enrolled in this study. Of these, 86 patients (35%) died and 34 patients had non-fatal cardiovascular events occurred at the last 7 years follow-up. The baseline eGFR obtained from the first quantified eGFR value within 6 months from the date of enrollment estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Then, based on eGFR at entry, we defined CKD as an eGFR < 60 mL/min/1.73 m², and stratified all patients into four groups: eGFR-1, normal eGFR (≥90 mL/min/1.73 m²); eGFR-2, mildly decreased eGFR (60-89 mL/min/1.73 m²); eGFR-3, moderately decreased eGFR (30-59 mL/min/1.73 m²); and eGFR-4, severely decreased eGFR (<30 mL/min/1.73 m²). The mean eGFR was 54.4 ± 28.9 mL/min/1.73m², and more than 30% of all patients had CKD (eGFR <60 mL/min/1.73m²). The seven-year cumulative incidence of MACE was 29.8% (95% confident interval [95% CI] 15.5-35.7) for eGFR-1 group, 40.4% (95% CI 27.4-45.2) for eGFR-2group, 66.2% (95% CI 47.6-71.4) for eGFR-3 group, and 94% (95% CI 75.0-99.0) for eGFR-4 group. In addition, after adjustment, hazard ratio (HR) for MACE was 2.36 (95% CI 1.26-4.40) in the eGFR-3 group and 7.62 (95% CI 3.71-15.66) in the eGFR-4 group. Restricted mean survival time (RMST) for survival analysis was consistent with HR in this study. After adjusting confounders, relative to eGFR-1 group, an association between the eGFR group and MACE outcome was found only in eGFR-3 group and eGFR-4 group. The moderate to severe reduction in eGFR, was an independent risk factor for MACE among DM patients with PAD throughout a 7-year follow-up duration. Thus, early CKD screening might be essential in the management of diabetic patients with PAD.

Keywords: adverse limb events; adverse major cardiovascular events; chronic kidney disease; diabetes; peripheral arterial disease.