Multimorbidity due to diabetes mellitus and chronic kidney disease and outcomes in chronic heart failure.

Pubmed ID: 19101236

Pubmed Central ID: PMC2659144

Journal: The American journal of cardiology

Publication Date: Jan. 1, 2009

MeSH Terms: Humans, Male, Female, Aged, Odds Ratio, Risk Factors, United States, Middle Aged, Diabetes Complications, Heart Failure, Treatment Outcome, Confidence Intervals, Cause of Death, Follow-Up Studies, Angiotensin-Converting Enzyme Inhibitors, Kidney Failure, Chronic, Morbidity, Survival Rate, Time Factors, Canada

Grants: R01 HL085561, P50-HL077100, K23 DK064649, K23 DK064649-04, R01 HL085561-02, 5-R01-HL085561-02, P50 HL077100

Authors: Ekundayo OJ, Ahmed A, Campbell RC, Aban IB, Ritchie C, Muchimba M

Cite As: Ekundayo OJ, Muchimba M, Aban IB, Ritchie C, Campbell RC, Ahmed A. Multimorbidity due to diabetes mellitus and chronic kidney disease and outcomes in chronic heart failure. Am J Cardiol 2009 Jan 1;103(1):88-92. Epub 2008 Oct 23.

Studies:

Abstract

Diabetes mellitus (DM) and chronic kidney disease (CKD) are common in patients with chronic heart failure (HF) and are associated with poor outcomes. However, the impact of multimorbidity due to DM and CKD on outcomes, relative to co-morbidity due to DM alone, has not been well studied in these patients. Of the 7,788 patients with chronic HF in the Digitalis Investigation Group trial, 2,218 had DM. We categorized these patients into those with DM alone (DM-only n = 1,123) and those with both DM and CKD (DM-CKD n = 1,095). Propensity scores for DM-CKD, calculated for each of the 2,218 patients, were used to match 699 pairs of patients with DM-only or DM-CKD. Matched Cox regression models were used to estimate associations between DM-CKD and outcomes. All-cause mortality occurred in 44% (rate 1,648/10,000 person-years) of patients with DM-CKD and 39% (rate 1,349/10,000 person-years of follow-up) of patients with DM-only (hazard ratio when DM-CKD was compared with DM-only 1.34, 95% confidence interval [CI] 1.11 to 1.62, p = 0.003). All-cause hospitalization occurred in 76% (rate 5,799/10,000 person-years) and 73% (rate 4,909/10,000 person-years) of patients with DM-CKD and DM-only, respectively (hazard ratio 1.16, 95% CI 0.99 to 1.36, p = 0.064). Respective hazard ratios for other outcomes were cardiovascular mortality 1.33 (95% CI 1.07 to 1.66, p = 0.010), HF mortality 1.41 (95% CI 1.02 to 1.96, p = 0.040), cardiovascular hospitalization 1.17 (95% CI 0.99 to 1.39, p = 0.064), and HF hospitalization 1.26 (95% CI 1.03 to 1.55, p = 0.026). In conclusion, compared with co-morbidity due to DM alone, the presence of multimorbidity due to DM and CKD was associated with increased mortality and morbidity in patients with chronic HF.