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Published on: November 18, 2018
Renal-diabetic overlap in pulmonary arterial hypertension
Matteo Toma1, Suela Vani2, Giulio Savonitto3
1Cardiovascular Disease Unit, IRCCS Azienda Ospedaliera Metropolitana, Genova, Italy.
Heart (British Cardiac Society)
|May 25, 2026
Summary
Pulmonary arterial hypertension (PAH) patients with co-occurring chronic kidney disease and/or diabetes mellitus (RD) face worse outcomes and higher mortality. These patients represent a significant unmet need in PAH treatment and management.
Area of Science:
- Cardiology
- Nephrology
- Endocrinology
Background:
- Comorbidities in pulmonary arterial hypertension (PAH) complicate management but offer therapeutic opportunities.
- Targeting comorbidities like chronic kidney disease (CKD) and diabetes mellitus (DM) can preserve renal function and maintain glucose homeostasis.
Purpose of the Study:
- To investigate the prevalence and outcomes of PAH patients with renal-diabetic (RD) overlap.
- To assess the relationship between RD overlap and all-cause mortality (ACM) or PAH hospitalization.
Main Methods:
- Retrospective analysis of an international cohort of incident PAH patients diagnosed between 2001-2023.
- Patients with CKD and/or DM were defined as renal-diabetic (RD).
- Kaplan-Meier curves and Cox proportional hazard regression were used to assess outcomes.
Main Results:
- 42% of 555 PAH patients were classified as RD, presenting with higher mortality risk at baseline and after 9 months.
- RD patients received less endothelin receptor antagonists and more single PAH therapy at diagnosis.
- RD patients experienced significantly more ACM/PAH hospitalizations and ACM alone compared to non-RD patients (HR 1.45 and 1.47, respectively).
Conclusions:
- PAH with RD overlap is a common clinical scenario with significant unmet therapeutic needs.
- Patients with RD overlap exhibit worse outcomes, including increased mortality and hospitalizations.
- Further research is needed to optimize treatment strategies for PAH patients with RD comorbidities.
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