Effects of diabetes mellitus in patients with heart failure and chronic kidney disease: a propensity-matched study of multimorbidity in chronic heart failure.

Pubmed ID: 19178965

Pubmed Central ID: PMC2720313

Journal: International journal of cardiology

Publication Date: May 29, 2009

MeSH Terms: Humans, Male, Female, Aged, Middle Aged, Diabetes Complications, Heart Failure, Follow-Up Studies, Kidney Failure, Chronic, Morbidity, Double-Blind Method, Diabetes Mellitus

Grants: R01 HL085561, P50-HL077100, K23 DK064649, K23 DK064649-04, R01 HL085561-02, 5-R01-HL085561-02, 1K07AG031779-01A1, K23 DK064649-02, K23 DK064649-05, P50 HL077100

Authors: Ekundayo OJ, Liu B, Ahmed A, Campbell RC, Aban IB, Ritchie C, Muchimba M, Frank SJ

Cite As: Ritchie C, Ekundayo OJ, Muchimba M, Campbell RC, Frank SJ, Liu B, Aban IB, Ahmed A. Effects of diabetes mellitus in patients with heart failure and chronic kidney disease: a propensity-matched study of multimorbidity in chronic heart failure. Int J Cardiol 2009 May 29;134(3):330-5.

Studies:

Abstract

BACKGROUND: Chronic kidney disease (CKD) and diabetes mellitus (DM) are common comorbidities in heart failure (HF) and each is associated with poor outcomes. However, the effects of multimorbidity related to having both CKD and DM compared to CKD alone have not been well studied in a propensity-matched population of chronic HF patients. METHODS: Of the 7788 ambulatory chronic HF patients in the Digitalis Investigation Group trial, 3527 had CKD, of whom 1095 had DM. Based on the absence or presence of DM, patients were categorized CKD-only and CKD-DM, respectively. Propensity scores for CKD-DM were calculated for each patient and were used to match 987 pairs of CKD-only and CKD-DM patients. Hazard ratios (HR) and 95% confidence intervals (CI) comparing CKD-DM patients with CKD-only patients were estimated using matched Cox regression models. RESULTS: All-cause mortality occurred in 47.0% (rate, 1783/10,000 person-years of follow-up) of CKD-DM patients and 39.6% (rate, 1414/10,000 person-years) of CKD-only patients (HR when CKD-DM is compared with CKD-only, 1.25; 95%-CI, 1.07-1.46; p=0.006). All-cause hospitalization occurred in 75.4% (rate, 5710/10,000 person-years) and 67.8% (rate, 4213/10,000 person-years) of CKD-DM and CKD-only patients respectively (HR, 1.32; 95%-CI, 1.15-1.52; p<0.0001). Respective HR and 95%-CI for other outcomes were: cardiovascular mortality (1.27; 1.06-1.52; p=0.009), HF mortality (1.34; 1.04-1.72; p=0.025); cardiovascular hospitalization (1.29; 1.12-1.49; p=0.001) and HF hospitalization (1.37; 1.16-1.63; p<0.0001). CONCLUSIONS: Compared with comorbidity due to CKD alone, multimorbidity with CKD and DM was associated with poor outcomes in chronic HF patients.