Heart failure and CKD raise mortality risk type 2 diabetes patients

Diabetes, chronic kidney disease (CKD), and heart failure (HF) are commonly occurring interlinked conditions. Studies have shown that about 25%-40% of patients with heart failure have diabetes, and 40%-50% of patients with heart failure have CKD. Both diabetes and CKD are associated with an increased risk of incident HF. Also, 40% of people with diabetes develop CKD, making diabetes the leading cause of kidney failure. 16% of patients with HF have both comorbid CKD and diabetes.

These three comorbidities are associated with a substantially increased mortality risk and hospitalization. Mechanisms underlying the relationships between HF, diabetes, and CKD are complex but likely related to shared metabolic and cardiovascular risk factors and downstream effects on neurohormonal pathways, oxidative stress, and inflammation.

Carolyn S. P. Lam, National Heart Research Institute of Singapore, Singapore, Singapore, and colleagues investigated the interplay of incident chronic kidney disease and heart failure and their associations with prognosis in a larger, population-based cohort with type 2 diabetes.

Using the territory-wide Clinical Data Analysis Reporting System, the researchers identified patients aged ≥18 with new-onset T2DM without heart failure or renal disease at baseline between 2000 and 2015. The follow-up of the patients was done for incident chronic kidney disease and heart failure, and all-cause mortality until December 31, 2020.

The study revealed the following findings:

• Among 102 488 patients (median age 66 years, 45.7% women, median follow-up 7.5 years), new-onset CKD occurred in 14.4% of patients, in whom 21.7% had HF.
• In contrast, among 9.0% with new-onset HF, 34.6% had CKD.
• The median time from baseline to incident CKD or HF (4.4 versus 4.1 years) did not differ. However, the median (interquartile range) time until incident HF after CKD diagnosis was 1.7 years and was 1.2 years for incident CKD after HF diagnosis.
• The crude incidence of CKD was higher than that of HF: 17.6 versus 10.6/1000 person-years, respectively, but incident HF was associated with higher adjusted mortality than incident CKD.
• The presence of either condition (versus CKD/HF-free status) was associated with a three-fold hazard of death. In contrast, concomitant HF and CKD conferred a six to seven-fold adjusted mortality hazard.

"Cardiorenal complications are common and are linked with poor prognosis among patients with new-onset T2DM," the researchers wrote. "Close monitoring of these dual complications is important to reduce disease burden."

Reference:

Wu MZ, Teng TK, Tay WT, Ren QW, Tromp J, Ouwerkerk W, Chandramouli C, Huang JY, Chan YH, Teramoto K, Yu SY, Lawson C, Li HL, Tse YK, Li XL, Hung D, Tse HF, Lam CSP, Yiu KH. Chronic kidney disease begets heart failure and vice versa: temporal associations between heart failure events in relation to incident chronic kidney disease in type 2 diabetes. Diabetes Obes Metab. 2023 Mar;25(3):707-715. doi: 10.1111/dom.14916. Epub 2022 November 29. PMID: 36346045.