TYPE 2 DIABETES AND CARDIORENAL SYNDROMES. A NATIONWIDE FRENCH HOSPITAL COHORT STUDY

Abstract

Objective: Type 2 diabetes mellitus (T2DM) is a risk factor for cardiac and renal complications ; its effect on cardiorenal syndromes is unknown. Design and method: In a French nationwide cohort of 5,123,193 patients hospitalised in 2012 with at least 5 years of follow-up, we assessed the effect of T2DM on cardiorenal syndrome incidence and outcomes based on cardiorenal syndrome's subtype (cardiorenal, renocardiac, and simultaneous) using 1:1 propensity matching. Results: Among 4,605,236 patients without cardiorenal syndrome, 391 186 (8·5%) with T2DM were matched to 380,581 to patients without T2DM. During follow-up, cardiorenal syndrome occurred in 104,788 patients (simultaneous: 25,225 [24.0%]; cardiorenal: 51,745 [49.4%]; renocardiac 27,818 [26.5%]). T2DM doubled the risk of incident CRS (1.30% vs 0.65%/year; adjusted hazard ratio [HR] for any cardiorenal syndrome: 1.92, 95% confidence interval (95%CI): (1.88 to 1.96); renocardiac: 2.21 (2.13 to 2.30); cardiorenal: 1.86 (1.81 to 1.91); simultaneous: 1.73 (1.66 to 1.81). Among the 26,396 patients with CRS at baseline, 11,355 (43.0%) had T2DM and were younger than non-diabetic patients (77.4±9.5 vs 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: 1.39 (1.29 to 1.50)), myocardial infarction (HR: 1.37 (1.21 to 1.56)), cardiovascular death (HR: 1.16 (1.10 to 1.23)), heart failure (HR: (1.17 (1.12 to 1.21)), and all-cause death (HR: 1.09 (1.05 to 1.12)), but not ischaemic stroke. Conclusions: Patients with T2DM represent almost half of patients with cardiorenal syndromes and are younger than their non-diabetic counterparts. T2DM doubles risk of cardiorenal syndrome and increases risk of death, cardiovascular outcomes, and end-stage kidney disease but not ischaemic stroke after cardiorenal syndrome.