181-OR: Declining eGFR over Time Predicts the Risk of a Composite of Primary or Secondary Major Adverse Cardiovascular Events or Heart Failure Hospitalization, in People with Type 2 Diabetes—EXSCEL Post Hoc analysis
Authors: OULHAJ ABDERRAHIM , SULIMAN ABUBAKER E. , ELLER KATHRIN , AZIZ FAISAL , COLEMAN RUTH L. , BENTOUMI RACHID , VON LEWINSKI DIRK , HOLMAN RURY R. , SOURIJ HARALD 
Published: June 2024

Introduction and Objective: Declining estimated glomerular filtration rate (eGFR) is a predictor for the development and progression of chronic kidney disease and incident cardiovascular disease (CVD). We used a novel statistical approach to investigate the role of eGFR decline in predicting CVD events in people with type 2 diabetes, in both primary and secondary CVD prevention settings.

Methods: Bayesian joint modelling of eGFR repeated measures and time to CVD event was applied to the Exenatide Study of Cardiovascular Event Lowering (EXSCEL) to examine the association between declining eGFR and the incidence of MACEhF (non-fatal myocardial infarction, non-fatal stroke, cardiovascular death, or hospitalization for heart failure), adjusting for age, sex, smoking, hypertension, antihypertensive medication, hyperlipidemia, lipid lowering medication, diabetes duration, atrial fibrillation, HDL-C, total cholesterol, HbA1c and treatment allocation (once-weekly exenatide or placebo).

Results: Data from 11374 trial participants with (n=8135) and without (n=3239) previous history of CVD were analyzed. The mean (SD) eGFR slope/year in participants without and with a history of CVD was -0.69 (1.73) and -0.97 (2.04) respectively. The corresponding 5-year MACEhF incidences were 7.6% (95% CI 6.3-8.9%) and 21% (95% CI 19-22%). A 1 SD decrease in the eGFR slope was associated with increased MACEhF risks of 64% (HR 1.64, 95% CI 1.15-2.28, p=0.007) and 22% (HR 1.22, 95%CI 1.03-1.45, p=0.026), respectively.

Conclusion: Declining eGFR over time is a significant predictor of incident MACEhF events in people with type 2 diabetes, both those with and without existing CVD, with a higher hazard ratio for MACEhF in the latter group.

Disclosure

A. Oulhaj: None. A.E. Suliman: None. K. Eller: Advisory Panel; Alexion Pharmaceuticals, Inc., AstraZeneca, Vifor Pharma Management Ltd. Speaker's Bureau; Boehringer-Ingelheim, Sanofi, CSL Behring. Advisory Panel; Takeda Pharmaceutical Company Limited. F. Aziz: None. R.L. Coleman: None. R. Bentoumi: None. D. von Lewinski: Speaker's Bureau; AstraZeneca. Research Support; Novo Nordisk. R.R. Holman: Advisory Panel; Anji Pharmaceuticals, AstraZeneca, Novartis AG. H. Sourij: Advisory Panel; Amarin Corporation. Speaker's Bureau; Amgen Inc., Amarin Corporation, Bayer Inc. Advisory Panel; Boehringer-Ingelheim. Speaker's Bureau; Boehringer-Ingelheim. Research Support; Boehringer-Ingelheim. Advisory Panel; Eli Lilly and Company. Research Support; Eli Lilly and Company. Speaker's Bureau; Eli Lilly and Company. Advisory Panel; Novartis AG. Speaker's Bureau; Novartis AG. Advisory Panel; Novo Nordisk. Research Support; Novo Nordisk. Speaker's Bureau; Novo Nordisk. Research Support; Sanofi. Speaker's Bureau; Sanofi. Consultant; K:Businesscom.