Eur J Intern Med. 2026 Oct 8:107232. doi: 10.1016/j.ejim.2026.107232. Online ahead of print.
ABSTRACT
OBJECTIVE: To quantify the association between diabetic kidney disease (DKD) phenotypes and cardiovascular disease (CVD) mortality and incident major adverse cardiovascular events (MACE), atrial fibrillation (AF), and peripheral artery disease (PAD).
METHODS: In this longitudinal analysis of adults with diabetes from NHANES (N = 5035) and the UK Biobank (UKBB, N = 26,968), participants were categorized by estimated glomerular filtration rate (eGFR, ml/min per 1.73m[2]) and urinary albumin-to-creatinine ratio (UACR, mg/g) into four phenotypes: no DKD (eGFR≥60, UACR<30), albuminuria-only (eGFR≥60, UACR≥30), low eGFR only (eGFR<60, UACR<30), and albuminuria+low eGFR (eGFR<60, UACR≥30). We estimated absolute and relative risk of CVD mortality (both cohorts) and incident non-fatal CVD (UKBB), adjusting for demographics, anthropometric and laboratory values, and medications.
RESULTS: In both cohorts, the albuminuria+low eGFR phenotype was associated with the highest cardiovascular risk versus no DKD (reference). In NHANES, albuminuria-only was more strongly associated with CVD mortality than low eGFR only: albuminuria-only HR 2.56 (95%CI 1.86-3.53), low eGFR only HR 1.92 (1.35-2.73), albuminuria+low eGFR HR 3.16 (2.27-4.41). In UKBB, the low eGFR only phenotype was associated with higher risk of CVD mortality than the albuminuria-only phenotype: albuminuria-only HR 1.88 (1.66-2.13), low eGFR only HR 2.42 (1.99-2.95), albuminuria+low eGFR HR 4.65 (3.78-5.71). In UKBB, the albuminuria+low eGFR phenotype exhibited the strongest association with MACE, AF, and PAD. Similar patterns were observed with absolute risk calculations.
CONCLUSIONS: Across two large cohorts, DKD phenotypes conferred distinct cardiovascular risk profiles. Consistent measurement of both eGFR and UACR in clinical practice may facilitate targeted, preventative cardiovascular care in diabetes.
PMID:42850142 | DOI:10.1016/j.ejim.2026.107232