The Clinical and Prognostic Significance of Diabetic Nephropathy in Diabetic Patients Undergoing Coronary Angiography

Objectives: We aimed to evaluate the influence of renal insufficiency on prognosis of diabetic patients undergoing coronary angiography.

Patients and methods: Consecutive 425 patients undergoing coronary angiography were enrolled. The mean follow up was 871 days. Patients were categorized into 2 groups according to the creatinine level: group I with level≤1.1 mg/dl and group II with level >1.1 mg/dl (309 (72.7%) and 116 (27.3%), respectively).

Results:

Patients in group II were older (73.6 vs 68.2, p<0.001), had higher prevalence of hypertension (94.8% vs 84.0%, p<0.001), lower HB (12.0 vs 12.9 g/L, p<0.0001) and higher CHA₂DS₂VASC score (4.66 vs 4.13, p=0.001). There was no significant difference between groups in rates of atrial fibrillation, LVEF, previous MI, CHF, presence of ACS, obstructive CAD and PCI performed.

Patients in group II had significantly higher total (29.3% vs 12.3%, p<0.0001) and early (1 year) mortality (17.2% vs 4.5%, p<0.0001).

Kaplan Meier analysis demonstrated significant association between renal insufficiency and decreased survival. In Cox regression model which combined renal insufficiency, high (>3) CHA₂DS₂VASC score, AF, LVEF, ACS, obstructive CAD on angiography and anemia, renal insufficiency was independently associated with higher total (HR 2.08, CI 1.24-3.48, p=0.005) and early mortality (HR 3.44, CI 1.63-7.15, p=0.001).

Conclusions: Renal insufficiency is an independent mortality predictor in diabetic patients undergoing coronary angiography.