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Abstract：
The evidence for the impact of renal dysfunction in patients with diabetes mellitus (DM) and first cardiovascular diseases on mid-term adverse outcomes remain scarce. This study included the data of patients with DM having first atherosclerotic cardiovascular disease (ASCVD) or congestive heart failure (CHF) from the Taipei Medical University Clinical Research Database. A Cox proportional hazards regression model was used to assess the impact of chronic kidney disease (CKD) or end-stage renal disease (ESRD) on the 1-year mortality and recurrent ASCVD/CHF outcomes. We enrolled 21,320 patients with DM hospitalized for ASCVD or CHF; of them, 18,185, 2639, and 496 were assigned to the non-CKD, CKD, and ESRD groups, respectively. After propensity score matching, compared with the non-CKD group, the CKD and ESRD groups had higher mid-term all-cause mortality (adjusted hazard ratio 1.72 [95% confidence interval 1.48-1.99] and 2.77 [2.05-3.73], respectively), cardiovascular death (1.84 [1.44-2.35] and 1.87 [1.08-3.24], respectively), and recurrent hospitalization for ASCVD (1.44 [1.24-1.68] and 2.33 [1.69-3.23], respectively) and CHF (2.08 [1.75-2.47] and 1.50 [1.04-2.17], respectively). The advancing age was associated with mortality in CKD/ESRD groups. In CKD group, male sex was associated with all-cause mortality and recurrent ASCVD risk; the diuretics usage was associated with mortality and recurrent CHF risks. Our findings suggest that CKD and ESRD are significant risk factors for mid-term adverse outcomes in patients with DM and established cardiovascular diseases. Additionally, old age, male sex and diuretics usage requires attention. Further good quality studies are needed in the future.
摘要：
糖尿病（DM）和首次心血管疾病患者肾功能不全对中期不良结局的影响的证据仍然很少。这项研究包括台北医科大学临床研究数据库中首次患有动脉粥样硬化性心血管疾病（ASCVD）或充血性心力衰竭（CHF）的DM患者的数据。Cox比例风险回归模型用于评估慢性肾病（CKD）或终末期肾病（ESRD）对1年死亡率和复发性ASCVD/CHF结局的影响。我们招募了21,320例因ASCVD或CHF住院的DM患者；其中，18,185、2639和496被分配给非CKD，CKD,和ESRD组，分别。在倾向得分匹配后，与非CKD组相比，CKD和ESRD组的中期全因死亡率较高(调整后的危险比1.72[95%置信区间1.48-1.99]和2.77[2.05-3.73],分别)，心血管死亡（1.84[1.44-2.35]和1.87[1.08-3.24]，分别)，和ASCVD的反复住院（1.44[1.24-1.68]和2.33[1.69-3.23]，分别)和瑞士法郎(2.08[1.75-2.47]和1.50[1.04-2.17]，分别)。老年与CKD/ESRD组的死亡率相关。在CKD组中，男性与全因死亡率和ASCVD复发风险相关;使用利尿剂与死亡率和CHF复发风险相关.我们的研究结果表明，CKD和ESRD是糖尿病和心血管疾病患者中期不良结局的重要危险因素。此外,老年,男性和利尿剂的使用需要注意。未来需要进一步高质量的研究。
