Premature Mortality in Type 2 Diabetes Mellitus Associated with Heart Failure and Chronic Kidney Disease: 20 Years of Real-World Data

Gavina, Cristina; Seabra, Daniel; Dias, Daniel Martinho; Bernardo, F.; Martinho, Hugo; Couceiro, João; Santos-Araújo, Carla; Dinis-Oliveira, Ricardo Jorge; Taveira-Gomes, Tiago

doi:10.3390/jcm11082131

Cited by 10 publications

(5 citation statements)

References 26 publications

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“…In fact, CKD is an increasingly recognized cardiovascular risk factor, associated with greater therapeutic burden, high healthcare costs and reduced life expectancy, as up to half of individuals with CKD die from cardiovascular disease [ 24–26 ]. Recently we demonstrated that the coexistence of heart failure and CKD is associated with increased premature mortality, as well as non-fatal cardiovascular events in T2DM patients <65 years old [ 27 , 28 ]. Moreover, in 2016 the European Guidelines on Cardiovascular Disease Prevention incorporated CKD as a non-traditional cardiovascular disease risk factor, readily identifiable from the analytical measurements of eGFR and UACR, and whose early identification and management may have a significant positive impact on cardiovascular disease prevention [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Twenty years of real-world data to estimate chronic kidney disease prevalence and staging in an unselected population

Santos-Araújo

Mendonça

Carvalho

et al. 2022

Clinical Kidney Journal

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Chronic kidney disease (CKD) represents a global public health burden, but its true prevalence is not fully characterized in the majority of countries. We studied the CKD prevalence in adult users of the primary, secondary and tertiary healthcare units of an integrated health region of the north of Portugal (n = 136 993; representing approximately 90% of the region adult population). Of them, 45 983 (33.6%) had at least two eGFR assessments and 30 534 (22.2%) had at least two urinary albumin creatinine ratio (UACR) assessments separated at least 3 months. CKD was defined according to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines as a persistent decrease in eGFR (<60 ml/min/1.73 m2) and/or increase in UACR (≥30 mg/g). The overall prevalence of CKD estimated was 9.8% and was higher in females (5.5%) than males (4.2%). From these, 4.7% were possible to stratified according to KDIGO guidelines. The prevalence of CKD was higher in older patients (specially in patients with more than 70-years-old) and in patients with comorbidities. This is the first real-world based study to characterize CKD prevalence in a large, unselected Portuguese population. It probably provides the nearest estimate of the true CKD prevalence and may help healthcare providers to guide CKD-related policies and strategies focused on prevention and on the improvement of cardiovascular disease and other outcomes.

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Section: Discussionmentioning

confidence: 99%

Twenty years of real-world data to estimate chronic kidney disease prevalence and staging in an unselected population

Santos-Araújo

Mendonça

Carvalho

et al. 2022

Clinical Kidney Journal

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“…Therefore, several studies concluded that inadequate physical activity raises the possibility of T2DM and CMS [ 72 - 75 ]. T2DM is the dominant cause of untimely loss of life [ 76 , 77 ]. Individuals with T2DM who are poorly therapeutically intervened often give rise to several health complications [ 78 ].…”

Section: Reviewmentioning

confidence: 99%

Type 2 Diabetes Mellitus and Cardiometabolic Prospects: A Rapid Narrative Review

Chowdhury,

Sinha,

Ahmad

et al. 2024

Cureus

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Cardiometabolic syndrome (CMS), type 2 diabetes mellitus (T2DM), and cardiovascular diseases are among the major altruists to the international liability of disease. The lifestyle and dietary changes attributable to economic growth have resulted in an epidemiological transition towards non-communicable diseases (NCDs) as the leading causes of death. Low- and middle-income countries (LMICs) bear a more substantial disease burden due to limited healthcare sector capacities to address the rapidly growing number of chronic disease patients. The purpose of this narrative review paper was to explore the interrelationships between CMS, T2DM, and cardiovascular impairments in the context of NCDs, as well as major preventative and control interventions. The role of insulin resistance, hyperglycemia, and dyslipidemia in the pathogenesis of T2DM and the development of severe cardiovascular impairments was highlighted. This paper elaborated on the pivotal role of lifestyle modifications, such as healthy diets and physical activity, as cornerstones of addressing the epidemics of metabolic diseases. Foods high in calories, refined sugar, red meat, and processed and ready-to-eat meals were associated with an amplified risk of CMS and T2DM. In contrast, diets based on fruits, legumes, vegetables, and whole grain, home-cooked foods demonstrated protective effects against metabolic diseases. Additionally, the role of a psychological and behavioral approach in addressing metabolic diseases was highlighted, especially regarding its impact on patient empowerment and the patient-centered approach to preventative and therapeutic interventions.

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“… 2 , 3 Among the most important conditions in patients with CKD are the presence of heart failure (HF) and diabetes mellitus (DM) 4 , 5 ; the complex interactions between the three are referred to as the cardio‐renal‐metabolic syndrome. 6 Despite prior studies having indicated that the coexistence of any of the other conditions worsens the prognosis 7 , 8 , 9 , 10 and the increasing focus on the treatment opportunities in multidisciplinary guidelines, 11 few studies have focused on the prognosis of the overlapping cardio‐renal‐metabolic components in CKD cohorts. While new therapies such as sodium‐glucose co‐transport 2 (SGLT2) inhibitors have been developed that especially benefit patients in this intersection, studies among patients with earlier CKD stages indicate that already recommended HF treatments, such as renin‐angiotensin‐aldosterone system inhibitors (RAASis), are under‐prescribed in this population.…”

Section: Introductionmentioning

confidence: 99%

Heart failure: the grim reaper of the cardio‐renal‐metabolic triad

Österman,

Al‐Sodany,

Haugen Löfman

et al. 2024

ESC Heart Failure

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AimsCurrent understanding of the prognosis for patients with chronic kidney disease (CKD) and overlapping cardio‐renal‐metabolic components, specifically heart failure (HF) and diabetes mellitus (DM), remains limited. While previous studies have explored the interactions between CKD, HF, and DM, they have predominantly focused on cohorts of HF or DM patients. This study aims to fill this gap by investigating the long‐term outcomes and treatment patterns in a cohort of CKD patients, particularly those with coexisting HF and DM.Methods and resultsWe analysed data from the Swedish national CKD patient cohort, the Swedish Renal Registry, with a follow‐up period extending up to 10 years. The study examined the risks of all‐cause mortality, major adverse cardiovascular events (MACE)—defined as a composite of non‐fatal myocardial infarction, hospitalization for congestive HF, non‐fatal stroke, or cardiovascular death—and the initiation of kidney replacement therapy (KRT). Analyses were conducted using Cox proportional hazards and competing risk models. Among the 27 647 patients, 48% had CKD alone, 12% had CKD with HF, 27% had CKD with DM, and 13% had CKD with both HF and DM. After 5 years, mortality rates were 23% for patients with CKD, 30% for those with CKD/DM, 54% for CKD/HF, and 55% for CKD/HF/DM. The 10 year absolute risk of MACE was 28% for CKD alone, 35% for CKD/DM, 67% for CKD/HF, and 73% for CKD/HF/DM. The adjusted hazard ratio (HR) for mortality was approximately three times higher in patients with any HF combination, with HRs of 2.57 [95% confidence interval (CI) 2.43–2.71] for CKD/HF and 3.22 (95% CI 3.05–3.39) for CKD/HF/DM, compared with CKD alone. The impact of HF on MACE prognosis was even more pronounced, with adjusted sub‐hazard ratios (SHRs) of 3.33 (95% CI 3.14–3.53) for CKD/HF and 4.26 (95% CI 4.04–4.50) for CKD/HF/DM. Additionally, CKD patients diagnosed with HF were less likely to commence KRT, and the risk of death prior to KRT initiation was roughly twice as high for these groups, with SHRs of 2.05 (95% CI 1.93–2.18) for CKD + HF and 2.43 (95% CI 2.29–2.58) for CKD + HF + DM.ConclusionsIn a cohort of CKD patients, having HF contributes substantially to increased mortality and the risk of MACE, and these patients are less likely to start KRT. These findings highlight the urgent need for targeted therapeutic strategies and management plans for CKD patients, particularly those with concurrent HF, to enhance patient prognosis.

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Premature Mortality in Type 2 Diabetes Mellitus Associated with Heart Failure and Chronic Kidney Disease: 20 Years of Real-World Data

Cited by 10 publications

References 26 publications

Twenty years of real-world data to estimate chronic kidney disease prevalence and staging in an unselected population

Twenty years of real-world data to estimate chronic kidney disease prevalence and staging in an unselected population

Type 2 Diabetes Mellitus and Cardiometabolic Prospects: A Rapid Narrative Review

Heart failure: the grim reaper of the cardio‐renal‐metabolic triad

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