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Type II diabetes mellitus is a risk factor for heart failure in pre-dialysis patients
Michio Kuwahara1, Junichi Ishigami, Satomi Shikuma
1Division of Nephrology, Shuuwa General Hospital, Kasukabe, Saitama, Japan. kuwaharam@shuuwa-gh.or.jp
Insights
Chronic kidney disease (CKD) patients with heart failure (HF) show distinct characteristics. Type II diabetic nephropathy and lower eGFR are independent risk factors for HF in CKD patients before dialysis.
Area of Science:
- Nephrology
- Cardiology
- Diabetology
Background:
- Chronic kidney disease (CKD) significantly elevates the risk of cardiovascular diseases, including heart failure (HF) and ischemic heart disease (IHD).
- Patient characteristics at the initiation of hemodialysis in those with CKD and HF remain under-evaluated.
- Understanding these characteristics is crucial for early detection and management.
Purpose of the Study:
- To evaluate the clinical and echocardiographic characteristics of patients with CKD and HF at the time of starting hemodialysis.
- To identify independent risk factors for HF in pre-dialysis CKD patients.
Main Methods:
- A cohort of 347 pre-dialysis CKD patients was studied.
- Patients were divided into two groups: those with HF (n=105) and without HF (n=242).
- Demographic, laboratory, causative disease, complication, and echocardiographic data were compared.
Main Results:
- Type II diabetic nephropathy (OR: 3.004) and estimated glomerular filtration rate (eGFR) (OR: 1.215 per 1 mL/min/1.73 m(2) increase) were identified as independent risk factors for HF.
- Left ventricular mass index (OR: 1.006 per 1 g/m(2) increase) was also an independent risk factor for HF.
- Left ventricular diastolic dysfunction was observed in over half of the patients.
Conclusions:
- CKD and type II diabetes mellitus are significant contributors to left ventricular dysfunction, leading to HF and IHD in pre-dialysis patients.
- Early identification of risk factors like diabetic nephropathy and left ventricular abnormalities is vital.
- Further research into managing cardiovascular risk in CKD patients is warranted.
Abstract:
Chronic kidney disease (CKD) increases the risk of developing cardiovascular diseases such as heart failure (HF) and ischemic heart disease (IHD). The characteristics of patients with CKD complicated with HF at the time of starting hemodialysis have not yet been evaluated. We enrolled 347 patients in this study and compared gender, age, body mass index, laboratory data, causative disease, complications, and echocardiographic findings between groups with (n = 105) and without (n = 242) HF. Type II diabetic nephropathy and estimated glomerular filtration rate (eGFR; mL/min/1.73 m(2) ) were the independent factors for HF (OR: 3.004, 95% CI: 1.754 to 5.146 and OR: 1.215, 95% CI: 1.101 to 1.330, [per 1 mL/min/1.73 m(2) increase], respectively). The higher GFR appeared to be not a risk factor for HF, probably because the HF group included patients who required periodic dialysis to prevent fatal HF, even if their renal function was not extremely deteriorated. The prevalence of hypertension, IHD and values of body mass index, triglycerides, and LDL-cholesterol did not differ between these two groups. Echocardiographic data showed that left ventricular mass index was an independent risk factor for HF (OR: 1.006, 95% CI: 1.001 to 1.012, per 1 g/m(2) increase) and more than half of the patients appeared to have left ventricular diastolic dysfunction. Our findings suggest that not only CKD, but also type II DM, is a potent risk for left ventricular dysfunction, which causes HF and IHD in pre-dialysis patients with CKD.
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