Serum ketone body levels and risk of incident kidney and cardiovascular events among patients with type 2 diabetes: a prospective cohort study

초록

Aim: To evaluate the associations between serum ketone body levels and kidney and cardiovascular outcomes in patients with type 2 diabetes. Methods: This prospective cohort analysis included 1392 clinically stable patients with type 2 diabetes who were not receiving insulin or thiazolidinedione therapy. Serum total ketone body concentrations were measured under stable outpatient conditions and categorized into tertiles: 0.08-92.3, 92.7-170.8, and 171.0-1629.6 & micro;mol/L. Kidney outcomes included new-onset macroalbuminuria, >= 40% decline in eGFR and end-stage kidney disease. Cardiovascular outcomes included myocardial infarction, revascularization, ischemic stroke, hospitalization for heart failure, and cardiovascular death. Results: During a median 23.2-month follow-up, 158 kidney and 64 cardiovascular events occurred. Compared with the lowest ketone body tertile, the highest ketone body tertile was associated with lower risk of >= 40% eGFR decline (adjusted HR [aHR], 0.46; 95%CI 0.26-0.84) and composite kidney outcomes (aHR 0.63; 95%CI, 0.41-0.98). Among participants with baseline eGFR >= 60 mL/min/1.73 m2, incident chronic kidney disease was also reduced (aHR 0.50; 95%CI 0.31-0.79). Cardiovascular outcomes showed favorable but non-significant trends. Conclusion: Mildly elevated serum ketone body levels were independently associated with lower adverse kidney outcomes in patients with type 2 diabetes, supporting their potential role as mediators of kidney risk.

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