P4483Relationship between chronic kidney disease and heart failure in patients with type 2 diabetes: a cohort study

Abstract

Introduction: Chronic kidney disease (CKD) and type 2 diabetes (T2D) are both individually associated with increased risk of cardiovascular diseases. However, studies investigating the prevalence of heart failure (HF) and its association with disease burden of CKD in T2D patients are scarce. Purpose(s): To examine the association of HF with CKD burden in T2D patients. Method(s): In this retrospective study, individuals with T2D and CKD were identified using ICD codes in the US claims database PharMetrics Plus. Baseline was defined as the first claim for CKD or T2D following a prior claim for the other condition. The observation period depended on the index date and ranged from 1 to 9 years. Prevalence of HF and CKD stage at baseline, as well as post-baseline clinical events, all-cause mortality rate and CKD progression stratified by presence of HF at baseline were reported. Result(s): At baseline, the prevalence of HF in 250,742 patients with both CKD and T2D was 18.1%, and increased with CKD severity from 7.9% at stage 1 to 26.4% at stage 5. Similarly, at baseline, the proportions of patients at early stages (1 and 2 combined, and 3) were lower for patients with HF (7.9 and 25.4%, respectively) than without (16.1 and 27.4%, respectively), whereas the proportion at more severe CKD stages (4, 5 and end stage renal disease combined) was higher in patients with HF (26.1%) than without (16.4%). However, these values may have been underestimated because approximately 40% of the population lacked CKD stage information (figure). Clinical outcomes reported during the observation period and stratified by presence of HF are summarised in the table. The proportion of patients who progressed to CKD stage 3 or more in one year was 19.0% in those with HF and 14.7% in those without. Annual mortality rates were 11.0% in patients with HF and 3.5% in those without. Conclusion(s): The present estimates indicate that the prevalence of HF in patients with T2D and CKD is higher than reported for the general population, and tend to increase with CKD severity. Similarly, patients with HF tended to be at a more severe CKD stage than those without. In addition, patients with HF at baseline were more likely to develop further co-morbidities, and to progress to a more severe CKD stage, than patients without HF. These findings suggest a strong association of CKD with HF in T2D patients. (Figure Presented).