TY - JOUR
T1 - Chronic kidney disease begets heart failure and vice versa
T2 - temporal associations between heart failure events in relation to incident chronic kidney disease in type 2 diabetes
AU - Wu, Mei-Zhen
AU - Teng, Tiew-Hwa Katherine
AU - Tay, Wan-Ting
AU - Ren, Qing-Wen
AU - Tromp, Jasper
AU - Ouwerkerk, Wouter
AU - Chandramouli, Chanchal
AU - Huang, Jia-Yi
AU - Chan, Yap-Hang
AU - Teramoto, Kanako
AU - Yu, Si-Yeung
AU - Lawson, Claire
AU - Li, Hang-Long
AU - Tse, Yi-Kei
AU - Li, Xin-Li
AU - Hung, Denise
AU - Tse, Hung-Fat
AU - Lam, Carolyn S P
AU - Yiu, Kai-Hang
N1 - Funding Information: We thank the Hospital Authority for access to the data, without which this research could not have been conducted. This study was supported by the Sanming Project of Medicine in Shenzhen, China (no. SZSM201911020) and supported by the HKU‐SZH Fund for Shenzhen Key Medical Discipline (no. SZXK2020081). Funding Information: HKU‐SZH Fund for Shenzhen Key Medical Discipline, Grant/Award Number: SZXK2020081; Sanming Project of Medicine in Shenzhen, China, Grant/Award Number: SZSM201911020 Funding information Publisher Copyright: © 2022 John Wiley & Sons Ltd.
PY - 2022/11/8
Y1 - 2022/11/8
N2 - Aim: To investigate the interplay of incident chronic kidney disease (CKD) and/or heart failure (HF) and their associations with prognosis in a large, population-based cohort with type 2 diabetes (T2DM). Methods: Patients aged ≥18 years with new-onset T2DM, without renal disease or HF at baseline, were identified from the territory-wide Clinical Data Analysis Reporting System between 2000 and 2015. Patients were followed up until December 31, 2020 for incident CKD and/or HF and all-cause mortality. Results: Among 102 488 patients (median age 66 years, 45.7% women, median follow-up 7.5 years), new-onset CKD occurred in 14 798 patients (14.4%), in whom 21.7% had HF. In contrast, among 9258 patients (9.0%) with new-onset HF, 34.6% had CKD. The median time from baseline to incident CKD or HF (4.4 vs. 4.1 years) did not differ. However, the median (interquartile range) time until incident HF after CKD diagnosis was 1.7 (0.5-3.6) years and was 1.2 (0.2-3.4) years for incident CKD after HF diagnosis (P < 0.001). The crude incidence of CKD was higher than that of HF: 17.6 (95% confidence interval [CI] 17.3-17.9) vs. 10.6 (95% CI 10.4-10.9)/1000 person-years, respectively, but incident HF was associated with a higher adjusted-mortality than incident CKD. The presence of either condition (vs. CKD/HF-free status) was associated with a three-fold hazard of death, whereas concomitant HF and CKD conferred a six to seven-fold adjusted hazard of mortality. Conclusion: Cardiorenal complications are common and are associated with high mortality risk among patients with new-onset T2DM. Close surveillance of these dual complications is crucial to reduce the burden of disease.
AB - Aim: To investigate the interplay of incident chronic kidney disease (CKD) and/or heart failure (HF) and their associations with prognosis in a large, population-based cohort with type 2 diabetes (T2DM). Methods: Patients aged ≥18 years with new-onset T2DM, without renal disease or HF at baseline, were identified from the territory-wide Clinical Data Analysis Reporting System between 2000 and 2015. Patients were followed up until December 31, 2020 for incident CKD and/or HF and all-cause mortality. Results: Among 102 488 patients (median age 66 years, 45.7% women, median follow-up 7.5 years), new-onset CKD occurred in 14 798 patients (14.4%), in whom 21.7% had HF. In contrast, among 9258 patients (9.0%) with new-onset HF, 34.6% had CKD. The median time from baseline to incident CKD or HF (4.4 vs. 4.1 years) did not differ. However, the median (interquartile range) time until incident HF after CKD diagnosis was 1.7 (0.5-3.6) years and was 1.2 (0.2-3.4) years for incident CKD after HF diagnosis (P < 0.001). The crude incidence of CKD was higher than that of HF: 17.6 (95% confidence interval [CI] 17.3-17.9) vs. 10.6 (95% CI 10.4-10.9)/1000 person-years, respectively, but incident HF was associated with a higher adjusted-mortality than incident CKD. The presence of either condition (vs. CKD/HF-free status) was associated with a three-fold hazard of death, whereas concomitant HF and CKD conferred a six to seven-fold adjusted hazard of mortality. Conclusion: Cardiorenal complications are common and are associated with high mortality risk among patients with new-onset T2DM. Close surveillance of these dual complications is crucial to reduce the burden of disease.
KW - cardiorenal syndrome
KW - chronic kidney disease
KW - heart failure
KW - incidence
KW - mortality
KW - type 2 diabetes mellitus
UR - http://www.scopus.com/inward/record.url?scp=85142910622&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/dom.14916
DO - https://doi.org/10.1111/dom.14916
M3 - Article
C2 - 36346045
SN - 1462-8902
JO - Diabetes, obesity & metabolism
JF - Diabetes, obesity & metabolism
ER -