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. 2023 May 2;3(4):611-621.
doi: 10.1016/j.jacasi.2023.03.005. eCollection 2023 Aug.

Association Between Diabetes, Chronic Kidney Disease, and Outcomes in People With Heart Failure From Asia

Claire A Lawson  1   2 , Wan Ting Tay  3 , Lizelle Bernhardt  1 , A Mark Richards  4   5   6 , Francesco Zaccardi  2   7   8 , Jasper Tromp  9   10 , Tiew-Hwa Katherine Teng  3   10   11 , Chung-Lieh Hung  12 , Chanchal Chandramouli  3   10 , Gurpreet Singh Wander  13 , Wouter Ouwerkerk  3   14 , Sam Seidu  2   7   8 , Kamlesh Khunti  2   7   8 , Carolyn S P Lam  3   10   15 ; ASIAN-HF Investigators
Affiliations

Association Between Diabetes, Chronic Kidney Disease, and Outcomes in People With Heart Failure From Asia

Claire A Lawson et al. JACC Asia. .

Abstract

Background: Diabetes mellitus (DM), chronic kidney disease (CKD), and heart failure (HF) are pathophysiologically linked and increasing in prevalence in Asian populations, but little is known about the interplay of DM and CKD on outcomes in HF.

Objectives: This study sought to investigate outcomes in patients with heart failure with preserved ejection fraction (HFpEF) vs heart failure with reduced ejection fraction (HFrEF) in relation to the presence of DM and CKD.

Methods: Using the multinational ASIAN-HF registry, we investigated associations between DM only, CKD only, and DM+CKD with: 1) composite of 1-year mortality or HF hospitalization; and 2) Kansas City Cardiomyopathy Questionnaire scores, according to HF subtype.

Results: In 5,239 patients with HF (74.6% HFrEF, 25.4% HFpEF; mean age 63 years; 29.1% female), 1,107 (21.1%) had DM only, 1,087 (20.7%) had CKD only, and 1,400 (26.7%) had DM+CKD. Compared with patients without DM nor CKD, DM+CKD was associated with 1-year all-cause mortality or HF hospitalization in HFrEF (adjusted HR: 2.07; 95% CI: 1.68-2.55) and HFpEF (HR: 2.37; 95% CI: 1.40-4.02). In HFrEF, DM only and CKD only were associated with 1-year all-cause mortality or HF hospitalization (both HRs: 1.43; 95% CI: 1.14-1.80), while in HFpEF, CKD only (HR: 2.54; 95% CI: 1.46-4.41) but not DM only (HR: 1.01; 95% CI: 0.52-1.95) was associated with increased risk (interaction P < 0.01). Adjusted Kansas City Cardiomyopathy Questionnaire scores were lower in patients with DM+CKD (HFrEF: mean 60.50, SEM 0.77, HFpEF: mean 70.10, SEM 1.06; P < 0.001) than with no DM or CKD (HFrEF: mean 66.00, SEM 0.65; and HFpEF: mean 75.80, SEM 0.99).

Conclusions: Combined DM and CKD adversely effected outcomes independently of HF subtype, with CKD a consistent predictor of worse outcomes. Strategies to prevent and treat DM and CKD in HF are urgently required.

Keywords: chronic kidney disease; comorbidity; diabetes; epidemiology; heart failure; outcomes.

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Conflict of interest statement

The ASIAN-HF study is supported by grants from Boston Scientific Investigator Sponsored Research Program, National Medical Research Council of Singapore, A∗STAR Biomedical Research Council ATTRaCT program, and Bayer. Dr Lawson is funded by the National Institute for Health Research (No. 30011). Dr Lam is supported by a Clinician Scientist Award from the National Medical Research Council of Singapore; has received research support from Bayer and Roche Diagnostics; has served as consultant or on the advisory board, steering committee, or executive committee for Actelion, Amgen, AnaCardio AB, Applied Therapeutics, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Cytokinetics, Darma Inc, EchoNous Inc, Impulse Dynamics, Ionis Pharmaceutical, Janssen Research & Development LLC, Medscape/WebMD Global LLC, Merck, Novartis, Novo Nordisk, Prosciento Inc, Radcliffe Group Ltd, Roche Diagnostics, Sanofi, and Us2.ai; and is co-founder & nonexecutive director of Us2.ai. Dr Zaccardi has received speaker fees from Napp Pharmaceuticals and Boehringer Ingelheim. Dr Tromp has received speaker fees from Daichii Sankyo and Roche Diagnostics; has received consultancy fees from Us2.ai; and holds a patent entitled “Automatic clinical workflow that recognizes and analyses 2D and doppler modality echocardiogram images for automated cardiac measurements and the diagnosis, prediction and prognosis of heart disease” unrelated to the present work. Dr Seidu reports receiving personal fees from Amgen, AstraZeneca, NAPP, Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Roche, Sanofi and Boehringer Ingelheim; has received grants from AstraZeneca, Sanofi, Servier and Janssen. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Central Illustration
Central Illustration
All-Cause Mortality or HF Hospitalization at 1 Year by HF Subtype Associations between the exposure groups, diabetes mellitus (DM) only, chronic kidney disease (CKD) only, and DM+CKD, compared with patients with no DM or CKD (reference group), with the primary composite outcome of 1-year mortality or heart failure (HF) admission. HFpEF = heart failure with preserved ejection fraction; HFrEF = heart failure with reduced ejection fraction.
Figure 1
Figure 1
Baseline Health-Related Quality of Life in HFrEF and HFpEF With 95% CI Estimated health-related quality of life at baseline for each exposure group: no diabetes mellitus (DM) or chronic kidney disease (CKD) (reference group), DM only, CKD only, and DM+CKD (DKD), by heart failure subtype. HFpEF = heart failure with preserved ejection fraction; HFrEF = heart failure with reduced ejection fraction; KCCQ = Kansas City Cardiomyopathy Questionnaire.
See this image and copyright information in PMC

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