Type 2 diabetes and cardiorenal syndromes. A nationwide French hospital cohort study

ElsevierVolume 49, Issue 3, May 2023, 101441Diabetes & MetabolismAuthor links open overlay panel, , , , , , , , , , , , AbstractAim

Type 2 diabetes mellitus (T2DM) is a risk factor for cardiac and renal complications; its effect on cardiorenal syndromes is unknown.

Methods

In a French nationwide cohort of 5,123,193 patients hospitalized in 2012 with ≥5 years of follow-up, we assessed the effect of T2DM on cardiorenal syndrome (CRS) (using cardiorenal, renocardiac, and simultaneous subtypes) incidence and outcomes using 1:1 propensity matching.

Results

Among 4,605,236 adults without cardiorenal syndrome, 380,581 (8.5%) with T2DM were matched to 380,581 adults without T2DM. During follow-up, CRS occurred in 104,788 patients: simultaneous n = 25,225 (24.0%); cardiorenal n = 51,745 (49.4%); renocardiac n = 27,818 (26.5%). T2DM doubled the risk of incident CRS (1.30% versus 0.65%/year; adjusted hazard ratio (HR) for any cardiorenal syndrome: 2.14 [95% confidence interval 2.10;2.19]; renocardiac: 2.43 [2.34;2.53]; cardiorenal: 2.09 [2.03;2.15]; simultaneous: 1.94 [1.86;2.03]. Among the 26,396 adults with CRS in 2012, 11,355 (43.0%) had T2DM and were younger than non-diabetic adults (77.4 ± 9.5 versus 82.3 ± 10.0); 8,314 patients with T2DM were matched to 8,314 patients without. T2DM increased risk of: end-stage kidney disease, adjusted HR 1.50 [1.39;1.62]; myocardial infarction 1.35 [1.19;1.53]; cardiovascular death 1.20 [1.13;1.27]; heart failure 1.17 [1.12;1.21]; and all-cause death 1.09 [1.06;1.13], but not ischemic stroke.

Conclusion

Patients with T2DM represent almost half of patients with CRS and are younger than their non-diabetic counterparts. T2DM doubles the risk of CRS and increases the risk of death, cardiovascular outcome, and end-stage kidney disease but not ischemic stroke after CRS.

Keywords

Cardiorenal syndrome

Cardiovascular

End-stage kidney disease

Epidemiology

Heart failure

Type 2 diabetes mellitus

AbbreviationsCKD

chronic kidney disease

CNIL

National Ethical Committee protecting human rights [Commission Nationale de l'Informatique et des Libertés]

DAPA-CKD

Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease

ESKD

end-stage kidney disease

ICD-10

International Classification of Diseases, Tenth Revision

PMSI

medicalized information system program [Programme de Médicalisation des Systèmes d'Information]

T2DM

type 2 diabetes mellitus

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