Canada: The albumin-to-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) are the risk factors for diabetes-related outcomes. A composite that combines information from both may provide a simple way of risk assessment.
Considering the above, Hertzel C. Gerstein, and colleagues in a recent study in Cardiovascular Diabetology have described a novel kidney disease index (KDI) that reflects both eGFR and ACR and predicted kidney and cardiovascular outcomes in type 2 diabetes. The researchers explained, "KDI combines the baseline ACR and eGFR into a novel composite risk factor that has a simple linear relationship with incident serious outcomes in patients with diabetes and additional CV risk factors.

In the post hoc epidemiologic analysis, the researchers included 9115 of 9901 Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) participants with both an ACR and eGFR at baseline. They estimated the hazard of higher baseline levels of 1/eGFR and natural log-transformed ACR and their interaction for incident kidney outcomes, major adverse cardiovascular events (MACE), and deaths. They also assessed the hazard of the geometric mean of these two baseline measures (the kidney disease index or KDI).
The study yielded the following findings:
· A non-linear relationship was observed between 1/eGFR and all three outcomes, and between ln [ACR × 100] and the kidney outcome.
· There was also a negative interaction between these two risk factors with respect to MACE and death.
· A linear relationship was noted between the KDI and all three outcomes.
· People in the highest KDI fifth experienced the highest incidence of MACE, death, and kidney outcome (4.43, 4.56, and 5.55/100 person-years respectively).
· C statistics for the KDI were similar to those for eGFR and albuminuria.
The researchers conclude, "the KDI could therefore simplify the identification of the highest risk individuals who will most likely benefit from preventive therapies."
"Its utility as a risk stratification tool should be assessed and confirmed in future epidemiologic studies and clinical trials."
Reference:
Gerstein, H.C., Ramasundarahettige, C., Avezum, A. et al. A novel kidney disease index reflecting both the albumin-to-creatinine ratio and estimated glomerular filtration rate, predicted cardiovascular and kidney outcomes in type 2 diabetes. Cardiovasc Diabetol 21, 158 (2022). https://doi.org/10.1186/s12933-022-01594-6