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Invited Commentary |

Glycemic Control and Cardiorenal Outcomes in Patients With Advanced Chronic Kidney Disease: Relative or Absolute Risks?  Comment on “Association Between Glycemic Control and Adverse Outcomes in People With Diabetes Mellitus and Chronic Kidney Disease”

David C. Goff, MD, PhD
Arch Intern Med. 2011;171(21):1927-1928. doi:10.1001/archinternmed.2011.520.
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Diabetes mellitus (DM) confers very high risk for cardiovascular disease (CVD).1 Chronic kidney disease (CKD) is a common complication of DM that further increases risk of CVD, the development of end-stage renal disease (ESRD), and other complications.2 Multiple interventions have been tested in patients with DM with the hope that these interventions might reduce the risk of CVD and microvascular complications.3 Unfortunately, persons with CKD have been excluded or, at least, underrepresented in these trials. For example, on the one hand, in order to use metformin in a manner consistent with its product label in the ACCORD trial (Action to Control Cardiovascular Risk in Diabetes), we excluded patients with elevated levels of creatinine, and, therefore, most individuals with CKD.4 On the other hand, the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation) trial included individuals with CKD.5 The ADVANCE investigators have reported the efficacy of the blood pressure (BP) lowering intervention on cardiovascular and renal outcomes in participants with CKD6; however, they have not yet published the results of their glucose-lowering intervention in this subgroup. Nevertheless, the results of the ADVANCE BP-lowering trial in CKD may be informative.

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