Rapid Kidney Function Decline Linked With Increased Heart Failure Risk in T2DM

Rapid kidney function decline is associated with an increased risk of heart failure (HF) in patients with type 2 diabetes (T2D), according to an investigation published in Cardiovascular Diabetology. 

Researchers included 7539 participants from the Action to Control Cardiovascular Risk in Diabetes (ACCORD; ClinicalTrials.gov Identifier: NCT00000620) study who had completed 4 years of follow-up or experienced a HF event during that period, had at least 3 recorded estimated glomerular filtration rate (eGFR) values, and available albumin-to-creatinine ratio (UACR) data. The team estimated associations between rapid kidney function decline and odds of HF, which was defined as death or hospitalization due to HF. Study participants completed questionnaires to provide demographic information, diabetes duration, smoking status, and medical and history.

During the 4-year follow-up duration, 1573 participants (20.9%) experienced rapid kidney function decline and 255 individuals (3.4%) had a HF event, according to the report. Regardless of cardiovascular disease history, rapid kidney function increased the risk of HF (odds ratio [OR], 3.23; 95% CI, 2.51–4.16; P <.0001).

Patients with a HF episode had a significantly more negative change in eGFR compared with participants without HF (median −3.9 vs −1.6 ml/min/1.73m²/year; P =.0002), which resulted in a higher rapid kidney function prevalence at follow-up (45% vs. 20%; P <.0001). Participants with a baseline eGFR less than 60 mL/min/1.73 m², increased baseline UACR, and rapid kidney function decline experienced an approximate 15-fold HF risk compared with individuals without these risk factors (OR, 14.53; 95% CI, 6.28-33.62). Adjusting for eGFR and UACR at baseline did not alter the association between rapid kidney decline and HF risk (OR 3.74; 95% CI, 2.63-5.31), the report shows.

Study limitations include a failure to consider treatment with glucose-lowering drugs developed after 2009 and an inability to generalize these findings for individuals with diabetes and lower cardiovascular risk.   

“Using rapid kidney function decline may help the early identification patients who could especially benefit from preventing treatment such as SGLT2 inhibitors …,” according to the study authors.