IMPACT OF ANAEMIA ON MAJOR CARDIOVASCULAR ADVERSE EVENTS IN DIABETIC KIDNEY DISEASE - RESULTS FROM A TERRITORY-WIDE STUDY

 

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https://storage.unitedwebnetwork.com/files/1099/f81672c87e7b8dd5186777dafbe4ddb1.pdf
IMPACT OF ANAEMIA ON MAJOR CARDIOVASCULAR ADVERSE EVENTS IN DIABETIC KIDNEY DISEASE - RESULTS FROM A TERRITORY-WIDE STUDY

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Edward Y. W.
Tam
Edward Y. W. Tam edward.tamyw@gmail.com Queen Mary Hospital Division of Nephrology, Department of Medicine Hong Kong Hong Kong, China *
Noel C. Yue ncyue2@connect.hku.hk Li Ka Shing Faculty of Medicine, The University of Hong Kong Department of Pharmacology and Pharmacy Hong Kong Hong Kong, China -
Ching-Lung Cheung lung1212@hku.hk Li Ka Shing Faculty of Medicine, The University of Hong Kong Department of Pharmacology and Pharmacy Hong Kong Hong Kong, China -
Desmond Y. H. Yap desmondy@hku.hk School of Clinical Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong Division of Nephrology, Department of Medicine Hong Kong Hong Kong, China -
 
 
 
 
 
 
 
 
 
 
 

Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease (CKD) and patients with DKD are at increased risk cardiovascular events. Anaemia is a common and important complication in CKD, and its effect on compounding major adverse cardiovascular events (MACE) and mortality in DKD patients remains unclear. This study aims to compare the risk of MACE and mortality in DKD patients with or without anaemia.

Clinical data from 1st January 2008 to 31st December 2018 were retrieved from a territory-wide electronic health record system in Hong Kong, China. All DKD patients without anaemia at baseline were identified. Patients who developed anaemia during the study period were matched to controls (i.e. patients who had not yet developed anaemia) in a 1:4 ratio using propensity score matching. The anaemia group was then followed onwards until occurrence of an event: MACE, end of study (i.e. 5 years from the date of CKD diagnosis), or development of anaemia in the matched control group, whichever occurred first. Primary outcome was MACE and secondary outcomes included non-fatal heart failure, hospitalization for any cause, and overall mortality. Time-to-event analysis was used to evaluate the association between development of anaemia and outcomes. 

745 DKD patients without anaemia at baseline were included. 11,949 patients developed anaemia during follow-up while 47,796 patients who did not. DKD patients with anaemia showed significantly higher risk developing MACE (HR 1.28; 95% CI 1.22 – 1.34, p < 0.001) (Figure 1). Risk of all-cause mortality (HR 6.55; 95% CI 6.04 – 7.09, p < 0.001), non-fatal heart failure (HR 1.42; 95% CI 1.32 – 1.52, p < 0.001) and all-cause hospitalization (HR 1.47; 95% CI 1.43 – 1.51; p < 0.001) were also increased in DKD patients who had developed anaemia compared with those who did not.

Figure 1. Kaplan-Meyer plot for Major Adverse Cardiovascular Events (MACE) in Diabetic Kidney Disease (DKD) patients with or without anaemia

Our results suggested that development of anaemia in DKD patients was associated with significantly escalated risk of MACE and other adverse clinical outcomes. Active investigation and management of anaemia in DKD patients may improve overall patient outcomes. 

Kewords