Abstract 12399: Impact of Heart Failure and Chronic Kidney Disease on Clinical Outcome in Relation to Presence of Type-2 Diabetes Mellitus - Results From the Population-Based Gutenberg Health Study

Abstract

Background: Type 2 diabetes mellitus (T2DM), heart failure (HF), and chronic kidney disease (CKD) are pathophysiologically linked and impact clinical outcome. The aim of this study was to determine the co-prevalence of T2DM, CKD and HF and to evaluate their additive prognostic significancefor all-cause mortality. Methods: Data from the population-based, prospective Gutenberg Health Study were analyzed (n=15,010). Clinical parameters were assessed during a highly standardized comprehensive 5-hour investigation at a dedicated study center. HF, T2DM and CKD were defined according to international guidelines. All-cause mortality was determined by regular checks of vital status via standardized follow-up examinations and regular alignment with registration offices. Results: In total 14,872 individuals were eligible for analysis (prevalence of T2DM: 8.6%; CKD: 29.1%; HF: 3.3%). During a median follow-up of 11.8 [interquartile range 10.3-13.2] years, 1,281 individuals died. In Cox regression analysis adjusted for age and sex, CKD and HF independently denoted an increased risk for all-cause mortality in diabetics (hazard ratio (HR) CKD 1.67 [95% confidence interval 1.33-2.09], P<0.0001; HR HF 2.44 [1.86-3.20], P<0.0001) and non-diabetics (HR CKD 1.22 [1.07-1.41], P=0.0042; HR HF 2.55 [2.07-3.14], P<0.0001). Further adjustment for traditional cardiovascular risk factors (CVRF) marginally reduced effect estimates. When considering the interaction of CKD and HF in Cox regression analysis, adjusted for age, sex, and CVRF, CKD without HF indicated a higher risk for all-cause mortality in diabetics (HR 1.66 [1.28-2.14], P=0.00011) compared with non-diabetics (HR 1.17 [1.01-1.36], P=0.04). A similar pattern, but with higher estimates was detected for HF without CKD (HR T2DM 2.56 [1.63-4.00], P<0.0001 vs. HR non-diabetics 2.13 [1.60-2.83], P<0.0001), and the highest were found for the co-prevalence of CKD and HF (HR T2DM 3.69 [2.59-5.27], P<0.0001 vs. HR non-diabetics 3.44 [2.54 - 4.65], P<0.0001). Conclusion: CKD and HF each show an independent but different risk for all-cause mortality that is modified by the prevalence of T2DM. The co-prevalence of these diseases increases mortality, underscoring the need for a holistic treatment approach.