Highest Diabetes Death Rates Seen in Trials Selecting for CKD

Selection for chronic kidney disease associated with highest mortality rates in randomized trials

WEDNESDAY, Feb. 22 (HealthDay News) -- In type 2 diabetes patients selected for randomized controlled trials (RCTs), chronic kidney disease (CKD) is associated with the highest overall risk of mortality, according to a review published online Feb. 21 in the Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease.

Ebrahim Barkoudah, M.D., of Brigham and Women's Hospital in Boston, and associates conducted a literature review and identified 22 eligible RCTs which reported all-cause mortality for patients with type 2 diabetes. The cohort comprised 91,842 patients and 6,837 deaths.

The researchers found that the mortality rate varied from 0.28 to 8.24 deaths per 100 patient-years across the cohort. Patients in the highest mortality category were more likely to be older, have higher blood pressure, and have longer duration of diabetes. Mortality rates were elevated in RCTs with previous cardiovascular morbidity; however, the selection for CKD correlated with the highest mortality rates.

"Mortality has a broad range of representation in trials of type 2 diabetes subjects. Moreover, diabetes trials with nephropathy selection had the highest death rates. We conclude that the selection for CKD, defined by either decline in renal function or presence of proteinuria, augmented the death risk in diabetes," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry. One author is a co-inventor on a patent for the use of inhibitors of the renin-angiotensin system in myocardial infarction survivors.

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