Creatinine Excretion Rate and Mortality in Type 2 Diabetes and Nephropathy

• Autores: Steef J. Sinkeler, Arjan J. Kwakernaak, Stephan J L Bakker, Shahnaz Shahinfar, Enrique Esmatjes Mompó
• Localización: Diabetes care, ISSN-e 0149-5992, Vol. 36, Nº. 6, 2013, págs. 1489-1494
• Idioma: inglés
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• Resumen

  • OBJECTIVE-The creatinine excretion rate (CER) is inversely associated with mortality in the general and renal transplant population. The CER is a marker for muscle mass. It is unknown whether the CER is associated with outcome in diabetes. We therefore investigated whether the CER is a determinant of all-cause mortality in diabetic patients.

    RESEARCH DESIGN AND METHODS-We used data from the combined Reduction of Endpoints in Non-insulin dependent diabetes mellitus with the Angiotensin II Antagonist Losartan (RENAAL) and Irbesartan Diabetic Nephropathy Trial (IDNT) studies. A total of 1,872 patients (58% of the overall population) with type 2 diabetes and nephropathy with valid 24-h urinary creatinine excretion data were included. The primary end point of the analyses was all-cause mortality.

    RESULTS-Mean age was 60 ± 8 years and median CER was 1,407 (total range 400-3,406) mg/day. Body surface area, hemoglobin, black race, and albuminuria were positive independent determinants of the CER, whereas female sex and age were inverse independent determinants of the CER. During a median follow-up of 36 (29-45) months, 300 patients died. In a Kaplan-Meier analysis of sex-stratified tenues of the CER, risk for all-cause mortality increased with decreasing CER (P < 0.001). In a multivariable Cox regression analysis, lower CER (as a continuous variable) was independently associated with increased risk for all-cause mortality (hazard ratio 0.39 [95% CI 0.29-0.52), P < 0.001). Adjustment for potential collection errors did not materially change these associations.

    CONCLUSIONS-Lower CER was strongly associated with increased all-cause mortality in patients with type 2 diabetes and nephropathy. As the CER can be considered a proxy for muscle mass, this puts renewed emphasis on physical condition and exercise in this population.