Diverging Association of Reduced Glomerular Filtration Rate and AlbuminuriaWith Coronary and Noncoronary Events in PatientsWith Type 2 Diabetes The Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study

OBJECTIVEdAlthough a reduced estimated glomerular filtration rate (eGFR) was shown to be a powerful independent predictor of cardiovascular disease (CVD), other studies suggested that it confers a much lower risk than albuminuria alone, whereas the combination of the two abnormalities is associated with multiplicative risk. This study aimed at assessing the indepen-dent association of previous CVD events, either total or by vascular bed, with eGFR and albu-minuria and chronic kidney disease (CKD) phenotypes. RESEARCH DESIGN AND METHODSdThis cross-sectional study evaluated 15,773 patients with type 2 diabetes from the Renal InsufficiencyAndCardiovascular Events (RIACE) Italian Multicenter Study in19outpatient diabetes clinics in years 2007–2008. Albuminuriawas assessedby immunonephelometry or immunoturbidimetry. GFR was estimated by the simplified Modification of Diet in Renal Disease Study and the Chronic Kidney Disease-Epidemiology Collaboration equa-tion. CKD was defined as an eGFR,60 mL/min/1.73 m2 or micro- or macroalbuminuria. Major acute CVD events were adjudicated based on hospital discharge records or specialist visits. RESULTSdCVD risk increased linearly with eGFR decline and albuminuria and became significant for values,78mL/min/1.73m2 and$10.5mg/24 h, respectively. Beyond traditional CVD risk factors, total CVD showed an independent association with albuminuria alone (odds ratio 1.20 [95%CI 1.08– 1.33]), reduced eGFR alone (1.52 [1.34–1.73]), and both abnormalities (1.90 [1.66–2.19]). However, coronary eventswere associated predominantlywith reduced eGFR alone,whereas cerebrovascular and peripheral events showed a stronger correlation with the albuminuric CKD phenotypes. CONCLUSIONSdThese data, although cross-sectional, show that reduced eGFR, irrespec-tive of albuminuria, is associated with significant CVD, particularly in the coronary district