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Abstract
Diabetes mellitus (DM) is a well-known risk factor for mortality, and the risk is exacerbated by coexisting diabetic kidney disease (DKD). We aimed to explore the impact of DM on each cause of mortality according to kidney function and the presence of albuminuria. Data on subjects with DM were extracted from the Nationwide Health Insurance Database of South Korea between 2009 and 2012. Subjects were divided by eGFR and albuminuria into five groups. To evaluate the risk of diabetes, we used the Cox proportional hazards model. A total of 2,614,662 patients were enrolled in this study. Most causes of death showed a higher incidence in an advanced stage of DKD. In addition to all-cause mortality and cardiovascular death, the risk of death from neoplasms and diseases of the endocrine, respiratory, and digestive systems is increased by albuminuria. The synergistic effect of a reduced eGFR and the presence of albuminuria was prominent in death from circulatory diseases, and endocrine and metabolic diseases. The risk for mortality was different according to the stage of DKD. Even in patients with a favorable eGFR, the presence of albuminuria significantly increased the risk for mortality, especially that due to cardiovascular causes.
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1 Chung-Ang University Gwang-Myeong Hospital, Department of Internal Medicine, Gwangmyeong-si, Korea (GRID:grid.254224.7) (ISNI:0000 0001 0789 9563)
2 Inje University Busan Paik Hospital, Department of Internal Medicine, Busan, Korea (GRID:grid.411625.5) (ISNI:0000 0004 0647 1102)
3 Seoul National University College of Medicine, Department of Internal Medicine, Seoul, Korea (GRID:grid.31501.36) (ISNI:0000 0004 0470 5905)
4 Uijeongbu Eulji University Medical Center, Department of Internal Medicine, Uijeongbu-si, Korea (GRID:grid.31501.36)
5 Gyeongsang National University Hospital, Department of Internal Medicine, Jinju-si, Korea (GRID:grid.411899.c) (ISNI:0000 0004 0624 2502)
6 Republic of Korea Air Force Education and Training Command, Department of Internal Medicine, Jinju-si, Korea (GRID:grid.31501.36); The Catholic University, Department of Biomedicine & Health Science, Seoul, Korea (GRID:grid.411947.e) (ISNI:0000 0004 0470 4224)
7 Keimyung University School of Medicine, Department of Internal Medicine, Daegu, Korea (GRID:grid.412091.f) (ISNI:0000 0001 0669 3109)
8 Seoul National University College of Medicine, Department of Internal Medicine, Seoul, Korea (GRID:grid.31501.36) (ISNI:0000 0004 0470 5905); Seoul National University Hospital, Department of Internal Medicine, Seoul, Korea (GRID:grid.412484.f) (ISNI:0000 0001 0302 820X)
9 Seoul National University Boramae Medical Center, Department of Internal Medicine, Seoul, Korea (GRID:grid.412479.d)
10 Seoul National University College of Medicine, Department of Internal Medicine, Seoul, Korea (GRID:grid.31501.36) (ISNI:0000 0004 0470 5905); Seoul National University Hospital, Department of Internal Medicine, Seoul, Korea (GRID:grid.412484.f) (ISNI:0000 0001 0302 820X); Kidney Research Institute, Seoul National University Hospital, Seoul, Korea (GRID:grid.412484.f) (ISNI:0000 0001 0302 820X)
11 Soongsil University, Department of Statistics and Actuarial Science, Seoul, Korea (GRID:grid.263765.3) (ISNI:0000 0004 0533 3568)