Diabetic Kidney Disease and Risk of Incident Stroke Among T2D Adults

Atherosclerotic cardiovascular disease (ASCVD) is a significant cause of morbidity and mortality among people with type 2 diabetes (T2D) . The huge burden of ASCVD in T2D, mainly coronary artery disease (CAD) and stroke, constitutes a major public health problem in this population and accounts for significant disability and healthcare costs.

Diabetes mellitus is associated with a 3-fold greater age-adjusted risk of stroke and a higher post-stroke mortality. The increased burden of stroke in individuals with T2D is driven in large part by the high prevalence of the metabolic syndrome components in this population. However, accruing evidence suggest that other factors such as diabetes-related microvascular complications might play a role. Indeed, diabetic retinopathy was found to be associated with higher risk of stroke in people with T2D.

A team of medical scientists collaborating with those at SOVAH Health (Danville, VA, USA) included in their study a total of 9,170 participants; mean age: 62.8 ± 6.6 years, 38.2% women, 62.9% white. Of the entire sample, 62.2% of participants had no chronic kidney disease (CKD); 13.3%, CKD G1; 14.1%, CKD G2; and 10.5%, CKD G3. Urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) were assessed at baseline.

Urine microalbumin was assayed on spot urine by immunonephelometry on a BN11 nephelometer (Siemens Healthineers, Erlangen, Germany). Urinary albumin excretion was estimated as the urine albumin-to-creatinine ratio (UACR) in mg albumin/g of creatinine. eGFR was calculated in mL/min/1.73 m² using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Serum and urine creatinine was measured via enzymatic methods on a Roche Double Modular P Analytics automated analyzer (Roche Diagnostics, Indianapolis, IN , USA).

The scientists reported that over a median follow-up of 4.9 years, 156 participants developed a stroke (incidence rate 3.6/1,000 person-years). After adjusting for relevant confounders, higher UACR and lower eGFR were each associated with increased risk of stroke. Compared to UACR < 30 mg/g, moderate albuminuria and severe albuminuria were associated with increasing hazards for stroke (HR 1.61 and 2.29 respectively). Compared to eGFR of ≥ 60 mL/min/1.73 m², decreased eGFR (eGFR < 60 mL/min/1.73 m²) was associated with higher risk of stroke (HR 1.50). Compared to no CKD, worsening CKD stage was associated with an increasing risk of stroke (HRs of 1.76 for CKD G1, 1.77 for CKD G2, and 2.03 for CKD G3).

The authors concluded that in a large and diverse cohort of adults with type 2 diabetes, higher UACR, decreased eGFR, and worsening CKD stages were associated with increased risk of stroke, independently of other stroke risk factors. The study was published on March 29, 2022 in the journal BMC Medicine.

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