Diabetes and cardiorenal syndrome: Understanding the "Triple Threat"

Diabetes is known to be associated with chronic kidney disease (CKD) and cardiovascular disease (CVD) independently. Type 2 cardiorenal syndrome (CRS), a recently defined syndrome, is characterized by primary renal failure that progressively leads to cardiac dysfunction. The effect of diabetes on cardiorenal syndrome has not been explored in a multi-ethnic population. In this retrospective secondary analysis, the hypothesis that diabetes modifies the effect of CVD on CKD was tested.

The National Health and Nutrition Examination Survey (NHANES) is a cross-sectional survey that was performed on the non-institutionalized population in the United States. All patients from the NHANES study, who were 20 years and older between the years 1999 and 2010, were included in the analysis. CKD was determined using the Cockcroft-Gault equation. The analysis was performed using a complex samples logistic regression to determine the relationship between diabetes and CRS.

The prevalence of CKD among the population was 9.6% in Non-Hispanic Whites, 8.9% in African-Americans, and 4.5% in Hispanics. The overall unadjusted odds ratio for CKD to no CKD was 6.89 (95% confidence interval [CI], 6.13-7.75, p < 0.001). The adjusted OR was elevated, 2.25 (CI 1.56-3.23, p < 0.001), among individuals with diabetes but was approximately 1.0 (1.43 CI 1.16-1.76, p < 0.05) among patients without diabetes after controlling for medical risk factors and demographic risk factors.

Diabetes is strongly associated with Type 2 CRS in a nationally representative multi-ethnic population and must be considered when treating patients. Longitudinal studies should further examine this association.