Nonalbuminuric DKD Ups CKD Progression Risk

DIABETIC KIDNEY disease (DKD) without albuminuria is significantly associated with higher risks for progression of chronic kidney disease (CKD), hospitalization for heart failure, and death, according to data published in the American Journal of Kidney Diseases.

The findings emerged from a study of 19,025 Chinese adults with type 2 diabetes enrolled in the Hong Kong Diabetes Biobank. Compared with patients who did not have DKD, those with a decreased estimated glomerular filtration rate (eGFR) only, albuminuria only, and albuminuria plus decreased eGFR had 2.4-, 3.8-, and 14.0-fold increased risks for a composite renal outcome of incident end-stage kidney disease or sustained eGFR reduction of 40% or greater, respectively, after adjusting for confounders, Ronald C.W. Ma, MD, of The Chinese University of Hong Kong, and colleagues reported in the American Journal of Kidney Diseases. They also had significant 3.1-, 3.1-, and 5.5-fold increased risks of hospitalization for heart failure, respectively, and 1.6-, 2.0-, and 3.3-fold increased risks for all-cause mortality.

In addition, compared with patients who did not have DKD, those with decreased eGFR only had a nonsignificant increased risk for cardiovascular disease and death when baseline eGFR was above 30 mL/min/1.73 m2, according to the investigators.

The study population had a mean age of 61.1 years. The mean duration of diabetes was 11.1 years. During 54,260 person-years of follow-up, 438 patients died and 298 hospitalizations for heart failure and 1161 episodes of CKD progression occurred. ■

Metformin May Affect PCa Risk

METFORMIN EXPOSURE in the previous year may increase the risk for prostate cancer, but exposure in the previous 2 to 7 years may lower the risk, according to a recent study.

Rachel Dankner, MD, MPH, of Sheba Medical Center in Ramat Gan, Israel, and colleagues conducted a population-based study of 145,617 men aged 21 to 90 years with newly diagnosed diabetes. Of these, 1592 were diagnosed with prostate cancer over 666,553 person-years of follow-up.

Patients exposed to metformin in the previous year had a significant 53% increased risk for a prostate cancer diagnosis per defined daily dose (DDD) before adjusting for glucose control and a significant 42% increased risk after adjusting for glucose control, Dr Dankner’s team reported in the American Journal of Epidemiology.

Patients exposed to metformin in the previous 2 to 7 years, however, had a significant 42% decreased risk for prostate cancer per DDD without adjusting for glucose control and a nonsignificant 40% decreased risk after adjustment. ■