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Diabetes-Kidney-Heart Continuum and Its Implication on Therapeutic Management

Abdul Hamid Zargar1, Jayagopal Pathiyil Balagopalan2, Arpandev Bhattacharyya3

  • 1Department of Endocrinology, Centre for Diabetes and Endocrine Care, Srinagar, IND.

Cureus
|August 27, 2025
PubMed

Insights

Type 2 diabetes (T2D) management requires understanding the kidney-heart continuum to prevent vascular complications. Early detection and risk stratification guide targeted therapies, improving outcomes for patients with diabetes.

Area of Science:

  • Endocrinology
  • Nephrology
  • Cardiology

Background:

  • Type 2 diabetes (T2D) frequently co-occurs with hypertension and hyperlipidemia, increasing risks of vascular complications, atherosclerosis, and subsequent heart or kidney damage.
  • While T2D's impact on cardiovascular disease (CVD) and chronic kidney disease (CKD) is studied, understanding the interconnected diabetes-kidney-heart continuum is crucial for clinical management.
  • Early detection of CVD and CKD risk in T2D patients can lead to targeted treatments, reducing hospitalizations and mortality.

Purpose of the Study:

  • To review the stages, pathophysiology, and management strategies for the diabetes-kidney-heart continuum.
  • To define patient profiles and risk factors associated with this continuum.
  • To summarize current and emerging pharmacotherapies and diagnostic approaches for vascular complications in T2D.

Main Methods:

  • Narrative review of existing literature.
  • Analysis of pathophysiological mechanisms linking diabetes, kidney, and heart disease.
  • Summary of pharmacotherapies and diagnostic tools.

Main Results:

  • Pharmacotherapies including SGLT-2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, lipid-lowering therapy, and RAAS blockers are discussed for managing cardiac and renal vascular changes.
  • Novel diagnostic approaches like BNP, cardiac troponin, cystatin C, and single-cell transcriptome sequencing show accuracy in detecting vascular complications.
  • Individual risk stratification is key for initiating, continuing, or switching therapies to improve treatment adherence and patient outcomes.

Conclusions:

  • Understanding the diabetes-kidney-heart continuum is vital for preventing morbidity and mortality in T2D patients.
  • Early detection of vascular complications through advanced diagnostics and risk stratification enables personalized treatment strategies.
  • Optimizing pharmacotherapy and adhering to treatment plans are essential for enhancing patient outcomes in T2D with co-morbidities.

Keywords:
cardiovascular diseasechronic kidney diseasediabetesdyslipidemiaguideline recommendationspharmacotherapy

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