Cardiac Dysfunction in Early Stages of Diabetic Kidney Disease- Fact or Fiction: A Case-control Study

Abstract

Introduction: The occurrence of kidney dysfunction in diabetics promotes early cardiac dysfunction. The timing of Diabetic Kidney Disease (DKD) and the impact of the stage of DKD on cardiac dysfunction is far from elucidated in current literature. Aim: To evaluate the association between the early stages of DKD and cardiac dysfunction by echocardiography. Materials and Methods: The present descriptive, case-control study was conducted in the Pondicherry Institute of Medical Sciences (PIMS), Kalapet, Puducherry, India, from November 2018 to November 2020. All diabetic patients between 25- 60 years, who attended the medicine Outpatient Department (OPD) or were admitted into the medical wards, were screened, among which 280 subjects were selected for the study. Patients with Estimated Glomerular Filtration Rate (eGFR) of more than 45 mL/min/1.73m2 were characterised as cases and those with eGFR of more than 90 mL/min/1.73m2 were controls. Echocardiographic parameters were recorded. Chi-square test, Mann-Whitney U test, and unpaired t-test were used for statistical analysis. Multivariate logistic regression analysis was done using an odd’s ratio to assess the association between early DKD and cardiac dysfunction. Results: The number of diabetics with early kidney disease (cases) were 139 and without kidney disease (controls) were 141. The mean age of the cases was 54.63±4.84 years and the controls were 52.61±7.916 years. The number of males among the cases and controls were 68 (48.92%) out of 139 and 96 (68.1%) out of 141, respectively. The prevalence of systolic dysfunction among diabetic patients with early kidney disease was 12.23% (17/139) and diastolic dysfunction was prevalent in 99.29% (138/139). Systolic dysfunction was 9.68 times more common in cases (n=139) than in controls (n=141). Women had a 2.6 times higher likelihood, and hypertension had (an independent association which was) a 2.6 times higher likelihood of developing cardiac dysfunction in the early stages of DKD. Conclusion: Systolic cardiac dysfunction is significantly higher (9.68 times more common) in those with early DKD when compared to those without kidney disease; with female gender and systemic hypertension as independent and significant risk factors.