Heart failure hospitalisation relative to major atherosclerotic events in type 2 diabetes with versus without chronic kidney disease: a meta-analysis of cardiovascular outcomes trials.

Abstract

AIM\nWe examined whether chronic kidney disease (CKD) modifies the frequency of heart failure hospitalisation (HHF) relative to atherosclerotic major adverse cardiovascular events (MACE; composite of cardiovascular death, myocardial infarction [MI], or stroke) in people with type 2 diabetes.\n\n\nMETHODS\nOf 16 cardiovascular outcomes trials in type 2 diabetes since 2013, seven reported outcomes stratified by estimated glomerular filtration rate (eGFR) category (<60 vs. ≥60\u2009ml/min/1.73\u2009m2), and five by albuminuria status. Placebo-arm incidence rates of HHF, MACE, MI and stroke were extracted for each eGFR and albuminuria subgroup.\n\n\nRESULTS\nCKD coincided with higher rates of all events, but the greatest increase was observed for HHF (2.65 times higher rate in subgroups with reduced eGFR [95% CI 2.24-3.14]; 2.67 times higher in those with albuminuria [95% CI 2.30-3.10]). By contrast, the rate of MACE was 1.77 (1.66-1.89) and 1.79 (1.58-2.02) times higher in those with reduced eGFR and albuminuria, respectively. In people with CKD, HHF occurred at a similar rate to MI (ratio of HHF:MI\u2009=\u20090.92 with eGFR <60, 0.94 with albuminuria), while in those without CKD, MI was significantly more common (HHF:MI\u2009=\u20090.58 with eGFR 60+ and 0.60 with normoalbuminuria). HHF rates exceeded stroke in people with CKD, but these events otherwise occurred at a similar rate. While reduced eGFR was associated with older age, no such differences between people with/without albuminuria explained their different event profile.\n\n\nCONCLUSION\nCKD is associated with a shift in the profile of cardiovascular events in people with type 2 diabetes, marked by a disproportionate increase in HHF relative to MACE.