Cardiovasc Diabetol: Synergistic effects of chronic kidney disease, neuropathy and retinopathy on all-cause mortality in diabetic patients

The prognostic value of common diabetes-related microvascular complications (MVCs), namely chronic kidney disease (CKD), cardiac autonomic neuropathy (CAN), peripheral neuropathy (DPN), and retinopathy (DR), is well established
.
However, the effects of different combinations of these complications on long-term mortality have not been adequately assessed
.

The researchers retrospectively analyzed 21 years of longitudinal data from 303 patients with type 1 or type 2 diabetes mellitus (T1D, T2D) who had clear certainty about the presence or absence of microvascular complications at baseline by 99 mTc-DTPA dynamic renal imaging, nocturnal urine collection, cardiovascular autonomic testing, monofilament testing, and dilated fundus examination
.

The effect of single microvascular complications on all-cause mortality

After 5244 person-years of follow-up, a total of 133 patients (43.
9%) died
.
The presence of chronic kidney disease and cardiac autonomic neuropathy increases the risk of corrected all-cause mortality by 117% and 54%,
respectively, regardless of other microvascular complications.
Concomitant chronic kidney disease and cardiac autonomic neuropathy were associated with the highest risk of death at baseline (HR 5.
08 [2.
52–10.
26]), followed by chronic kidney disease and retinopathy (HR 2.
95 [1.
63–5.
32]) and cardiac autonomic neuropathy and retinopathy (HR 2.
07 [1.
11–3.
85]).

The risk of death (HR 1.
52 [0.
87 to 2.
67]) was numerically higher in patients with any single microvascular complication than in patients without microvascular complications, and the risk of death was increased by 203% (HR 3.
03 [1.
62 to 5.
68]) and 692% (HR 7.
92 [2.
93 to 21.
37]),
respectively, in patients with two and three microvascular complications.

Effect of multiple microvascular complications on all-cause mortality in patients

This study demonstrates the long-term, synergistic, and negative effects of single and multiple diabetic microvascular complications on all-cause mortality in patients with diabetes, suggesting that patients with T1D and T2D should be screened for comprehensive microvascular complications to improve risk stratification and treatment
.

Original source:

Sacchetta, L.
, Chiriacò, M.
, Nesti, L.
et al.
Synergistic effect of chronic kidney disease, neuropathy, and retinopathy on all-cause mortality in type 1 and type 2 diabetes: a 21-year longitudinal study.
Cardiovasc Diabetol 21, 233 (2022).
https://doi.
org/10.
1186/s12933-022-01675-6