Risk Factor Analysis of Cardiovascular Events in Patients With Diabetic Kidney Disease and Hypertension: A Retrospective Study.

Abstract

Aims/background: Diabetic kidney disease (DKD) is among the most prevalent complications of diabetes and is commonly accompanied by hypertension as a comorbid condition. The coexistence of these two conditions markedly augments the risk of cardiovascular disease. Although traditional risk factors such as dyslipidemia, smoking, and decreased renal function have been shown to be associated with increased cardiovascular events, evidence for the higher-risk subgroup of "DKD with hypertension" remains relatively limited. This study aimed to retrospectively analyze the influencing factors of adverse cardiovascular events in this population and assess the independent predictive value of different clinical indicators.

Methods: In this single-center retrospective cohort study, 204 patients diagnosed with DKD and hypertension were enrolled between January 2021 and January 2024. Baseline data, including patient demographics and clinical indicators, were collected. Patients were divided into an event group and a non-event group based on whether they experienced cardiovascular events during the 12-month follow-up period. Independent risk factors were screened using univariate and multivariate logistic regression, and the effects of prior hyperlipidemia and smoking on event-free survival were assessed using Kaplan-Meier curves.

Results: Compared with the non-event group, patients in the event group had significantly higher levels of low-density lipoprotein (LDL), urinary protein, and kidney injury molecule-1 (KIM-1), and significantly lower levels of high-density lipoprotein (HDL), along with a greater prevalence of prior hyperlipidemia and smoking (all p < 0.05). Univariate analysis showed that prior hyperlipidemia, smoking, elevated LDL, reduced HDL, and increased KIM-1 were all associated with cardiovascular events. Further multivariate analysis confirmed that prior hyperlipidemia, smoking, HDL, LDL, and KIM-1 were all independent predictors of cardiovascular events (all p < 0.05). According to Kaplan-Meier curve analysis, patients with a history of hyperlipidemia and a smoking habit had significantly lower event-free survival than those without these characteristics (p = 0.034 and p = 0.024).

Conclusion: In DKD patients with hypertension, prior hyperlipidemia, smoking, elevated LDL, reduced HDL, and increased KIM-1 were key independent risk factors for cardiovascular events. The adverse association of dyslipidemia and smoking with event-free survival was evident early in the follow-up period. These results suggest that this high-risk population should receive enhanced lipid management and smoking cessation interventions, and the potential value of renal tubular injury markers (such as KIM-1) in cardiovascular risk assessment should be investigated to facilitate early identification of high-risk individuals and the development of individualized prevention strategies.