# Diabetic kidney disease as an independent predictor of long-term adverse outcomes in patients with coronary artery disease and diabetic mellitus

## TL;DR

This study shows that diabetic kidney disease increases the risk of long-term heart problems in patients with diabetes and coronary artery disease after heart procedures.

## Contribution

The study identifies diabetic kidney disease as an independent predictor of adverse outcomes in CAD patients with diabetes after PCI.

## Key findings

- Patients with DKD had a 40.3% MACE rate compared to 52.2% in non-DKD patients.
- DKD was an independent predictor of MACE, cardiovascular death, and all-cause death after adjusting for variables.

## Abstract

Diabetic kidney disease (DKD) had been proposed as a contributor in the pathogenesis of coronary artery disease (CAD). However, the relationship of DKD and the long-term adverse outcomes in patients with CAD after percutaneous coronary intervention (PCI) was still undiscovered.

Approximately 892 patients with CAD enrolled from January 2012 to December 2016. The patients were divided into two groups, the DKD group (n = 341) and the None DKD group (n = 551). The primary outcome was major adverse cardiac events (MACE) after PCI. The average follow-up time was 1,897 ± 1,276 days.

Baseline data showed that some factors were significantly different between the two groups, including age, body mass index, gender (female), hypertension, smoking, stroke history, heart failure, duration of diabetic mellitus (DM), low-density lipoprotein cholesterol, urinary protein/creatinine ratio, serum creatinine, hemoglobin, platelet, antiplatelet, beta blocker, statin, antihypertensive drugs, and insulin (all p < 0.005). There were significant differences between the two groups in MACE, 40.3% vs. 52.2% (p = 0.001), and in cardiovascular death events and all-cause death events (5.6% vs. 20.5%, p < 0.001 and 4.4% vs. 13.5%, p < 0.001, respectively). In the DKD group, the risk of MACE was elevated to 141.9% [hazard ratio (HR) = 1.419, 95% confidence interval (CI): 1.164–1.730, p = 0.001] in the Cox univariable regression analyses; after adjusting co-variables, the Cox multivariable regression analyses demonstrated that DKD was an independent predictor for MACE (HR = 1.291, 95% CI: 1.027–1.624, p = 0.029) in patients with CAD after PCI, as well as in cardiovascular death events (HR = 2.148, 95% CI: 1.292–3.572, p = 0.003) and all-cause death events (HR = 2.229, 95% CI: 1.325–3.749, p = 0.003).

This study suggests that DKD is an independent and novel predictor of long-term adverse outcomes in patients with CAD and DM who underwent PCI.