scholarly journals Clinical course and related costs of patients with diabetes and heart failure and/or chronic kidney disease, drawn from a sample of more than 7 million people

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A.P Maggioni ◽  
C Piccinni ◽  
S Calabria ◽  
L Dondi ◽  
G Ronconi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Metabolic Diseases ◽  
Clinical Epidemiology ◽  
Community Setting ◽  
Private Company ◽  
Funding Sources ◽  
Patients With Diabetes ◽  
Artery Disease

Abstract Background Diabetes (T2DM), heart failure (HF) and chronic kidney disease (CKD) are among the leading causes of mortality and hospitalization worldwide. This analysis of the Ricerca e Salute (ReS) database is aimed to describe clinical epidemiology, 2-year outcomes and direct costs of T2DM patients with HF, CKD or both in a community setting. Methods Analyses were performed on the ReS database including 7,365,716 subjects. During 2015, subjects with T2DM were selected and subsequently split in the following mutually exclusive cohorts (Figure): – “healthy” T2DM patients, subjects with T2DM but without coronary artery disease (CAD), HF, stroke, TIAs, peripheral artery disease (PAD) and CKD. – Patients affected by T2DM and HF. – Patients affected by T2DM and CKD. – Patients affected by T2DM and both HF and CKD. Results Table shows the baseline characteristics, hospitalization reasons, and related costs of the 4 cohorts. In the 2-year follow-up, T2DM patients with comorbidities are older, more frequently males, and more often admitted for CV and renal reasons. T2DM patients with both HF and CKD have the worst outcome profile. The cost per patient per year is 5 times more for T2DM patients with both HF and CKD than for those with T2DM without these comorbidities. Conclusions Coexistence of HF and/or CKD in patients with T2DM ia associated with a very high clinical and economical burden. Instead of treating each condition individually, the most appropriate approach should be to adopt a collaborative approach that embraces CV, renal and metabolic diseases. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): This research was partially supported by an unrestricted grant from Astra Zeneca. Astra Zeneca was not involved in data collection, analysis and interpretation, in writing the report, nor in deciding to submit the article for publication.

scholarly journals The effects of dapagliflozin on kidney and cardiovascular outcomes in patients with chronic kidney disease with and without heart failure

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J L Heerspink ◽  
D C Wheeler ◽  
P Vart ◽  
N Jongs ◽  
F F Hou ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Premature Mortality ◽  
Cardiovascular Death ◽  
Private Company ◽  
Double Blind ◽  
Funding Sources

Abstract Background Heart failure (HF) is highly prevalent in patients with chronic kidney disease (CKD) and the severity of kidney impairment increases risk of HF, highlighting the deleterious interplay between the conditions. The DAPA-CKD trial showed that dapagliflozin reduced the risk of kidney failure and HF hospitalization in patients with CKD. Purpose This prespecified analysis of DAPA-CKD aimed to determine the effects of dapagliflozin on kidney, cardiovascular and mortality outcomes according to presence or absence of HF. Methods DAPA-CKD (NCT03036150) was a randomized, double blind, controlled trial, which enrolled 4,304 participants with CKD. Participants were randomized to dapagliflozin 10 mg/day or placebo, as adjunct to standard care, and were followed for a median 2.4 years. The primary endpoint was a composite of sustained decline in eGFR ≥50%, end-stage kidney disease, or renal or cardiovascular death. Key secondary endpoints included a composite of cardiovascular death or HF hospitalization and all-cause mortality. Results Overall, 468 (11%) participants had a HF diagnosis at baseline. Participants with HF were older (65.3 vs 61.4 years) and more frequently diagnosed with type 2 diabetes (77% vs 66%) compared with those without HF; mean eGFR was similar (43.2 vs 43.1 mL/min/1.73m2) in the two groups. The primary outcome occurred more frequently in those with versus without HF (8.8 vs 5.7 events per 100 patient-years, respectively). The effect of dapagliflozin on the primary outcome was consistent among those with (hazard ratio [HR] 0.58; 95% CI 0.37, 0.91) or without HF (HR 0.62; 95% CI 0.51, 0.75; p-interaction 0.59). The composite of cardiovascular death or HF hospitalization (HR 0.68; 95% CI 0.44, 1.05 vs 0.70; 95% CI 0.51, 0.97; p-interaction 0.90), and the relative risk reduction for mortality (HR 0.56; 95% CI 0.34, 0.93; vs 0.73; 95% CI 0.54, 0.97; p-interaction 0.39) were also consistent in those with or without HF. Conclusion Patients with co-existing CKD and HF are at high risk of kidney and cardiovascular events and premature mortality. Dapagliflozin consistently reduced the proportional risk of these events, regardless of the presence or absence of HF. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): AstraZeneca

Abstract 15209: LPA Variants Are Associated With Aortic Valve Stenosis, Heart Failure and Chronic Kidney Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ozan Dikilitas ◽  
Benjamin A Satterfield ◽  
Maya Safarova ◽  
Shoa L Clarke ◽  
Catherine Tcheandjieu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Aortic Valve ◽  
Aortic Valve Stenosis ◽  
European Ancestry ◽  
Atherosclerotic Cardiovascular Disease ◽  
Disease Phenotypes ◽  
Emerge Network ◽  
Artery Disease

Background: The pathophysiology of lipoprotein (a) [Lp(a)] remains obscure. We conducted a phenome wide analysis study (PheWAS) to identify pleiotropic effects of LPA variants. Methods: Among 51,843 European-ancestry participants (age 58±16 years, 54% female) of the electronic MEdical Records and Genomics (eMERGE) network we assessed whether LPA variants exhibited pleiotropic affects through an electronic health record-based PheWAS. We adjusted significant associations by presence of atherosclerotic cardiovascular disease (ASCVD; defined as a composite of coronary heart disease, cerebrovascular disease, and peripheral artery disease) to determine whether those associations were independent of ASCVD. Results: In PheWAS analysis, we tested 864 phecodes with 36 independent LPA variants. We identified 21 significant associations with non-ASCVD phenotypes including heart failure, aortic valve stenosis, and chronic kidney disease of which 14 were replicated across independent cohorts. The strength of associations between the LPA variant rs10455872 and both heart failure and aortic valve stenosis related phecodes were significantly attenuated after adjustment for ASCVD. However, the association with chronic kidney disease phecode remained independent following adjustment for ASCVD without any attenuation in the estimated odds ratio (Table). Conclusions: LPA genetic variants were associated with aortic valve stenosis, heart failure and chronic kidney disease. The observed association of LPA variant rs10455872 with aortic stenosis and heart failure appear to be partially mediated by ASCVD, while the association with chronic kidney disease appears to be independent of ASCVD. Additional studies are needed to elucidate potential mechanisms by which Lp(a) may contribute to the pathogenesis of non-ASCVD disease phenotypes.

scholarly journals Critical factors leading to wound complications in amputated patients: low hematocrit levels

2020 ◽  
Vol 8 (1) ◽  
pp. 39
Author(s):  
Sinan Omeroglu ◽  
Ibrahim Demir ◽  
Metin O. Beyaz
Keyword(s):  
Chronic Kidney Disease ◽  
Risk Factor ◽  
Kidney Disease ◽  
Lower Extremity ◽  
Wound Complications ◽  
Critical Factors ◽  
Peripheral Artery ◽  
Diabetic Foot Infection ◽  
Patients With Diabetes ◽  
Artery Disease

Background: Patients with diabetes-induced lower extremity infection and gangrene suffer from post-amputation wound complications. The aim of this report is to identify critical factors leading to wound complications in amputated patients.Methods: 50 patients with ipsilateral transmetatarsal (TMA) or finger amputation treated in Istanbul University Medical Faculty between 2001 and 2013 were retrospectively reviewed. Amputations were caused by diabetic foot infection. None of the patients had peripheral artery disease (ABPI>1.1).Results: In 9 (18%) patients, revision was required despite appropriate antibiotherapy after amputation. 7 (78%) of these patients were women, 8 (89%) were smokers and hematocrit levels were below 25% in all of them. 4 of the 5 patients (80%) with chronic kidney disease were among the patients in need of revision.Conclusion: The risk of wound complications after amputation is high. These complications increase morbidity and treatment costs. This study showed that low hematocrit value is a risk factor for the development of wound infection after amputation.

Cardiovascular imaging in chronic kidney disease

ESC CardioMed ◽  
2018 ◽  
pp. 987-993
Author(s):  
Victoria Delgado
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Congestive Heart Failure ◽  
Heart Disease ◽  
Kidney Disease ◽  
Renin Angiotensin System ◽  
Structural Heart Disease ◽  
Cardiovascular Imaging ◽  
Traditional Risk Factors ◽  
Artery Disease

Chronic kidney disease (CKD) is associated with increased cardiovascular morbidity and mortality. Congestive heart failure, coronary artery disease (CAD), cardiac arrhythmias and valvular heart disease are the most prevalent cardiovascular diseases in patients with CKD and account for 50% of all-cause mortality of patients with end stage renal disease.1 Particularly, congestive heart failure is the most prevalent cardiovascular condition in CKD patients and its prevalence increases as the kidney function declines. Pressure overload, as a consequence of long-standing hypertension and vascular stiffness, volume overload and CKD-related non-hemodynamic factors, such as inappropriate activation of the renin-angiotensin system, inflammation and stimulation of pro-hypertrophic and profibrogenic factors, are the main pathophysiological drivers of congestive heart failure.1 These factors along with a greater prevalence of traditional risk factors have been also associated to the pathogenesis of coronary plaque formation and rupture and reduced coronary flow reserve, peripheral artery disease and stroke. For the clinical cardiologist, the evaluation of CKD patients comprises the following areas:1. Is there structural heart disease? 2. Is there CAD?3. Atrial fibrillation and associated risk of embolic stroke4. Risk of sudden cardiac death (SCD)This section provides an overview on the use of multimodality cardiovascular imaging to diagnose and manage these cardiovascular complications.

scholarly journals Acute Heart Failure Comorbidome: The Impact of Everything Else

2020 ◽  
Vol 33 (2) ◽  
pp. 109
Author(s):  
Mariana Alves Meireles ◽  
João Golçalves ◽  
João Neves
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Chronic Heart Failure ◽  
Kidney Disease ◽  
Confidence Interval ◽  
Acute Heart Failure ◽  
Odds Ratio ◽  
Peripheral Artery ◽  
Artery Disease

Introduction: Heart failure frequently coexists with several comorbidities. Our aim is to evaluate the prognostic role of various comorbidities in the risk of acute heart failure development.Material and Methods: Comorbidities of patients with acute heart failure were, retrospectively, compared to a control group of patients with chronic heart failure admitted to an Internal Medicine unit in a 2-year period. Logistic regression models were constructed to determine their association with acute heart failure and to develop a comorbidome.Results: We identified 229 patients with acute heart failure and 201 patients with chronic heart failure. Age and female gender were higher in acute heart failure group (p < 0.001) as was the number of comorbidities (4.0 ± 3.0 vs 4.0 ± 2.0, p = 0.044). Hyperuricemia (odds ratio 2.46, confidence interval 95% 1.41 - 4.31, p = 0.002), obesity (odds ratio 2.22, confidence interval 95% 1.31 - 3.76, p = 0.003), atrial fibrillation (odds ratio 1.93, confidence interval 95% 1.31 - 2.87, p = 0.001), peripheral artery disease (odds ratio 2.12, confidence interval 95% 1.01 - 4.42, p = 0.046) and chronic kidney disease (odds ratio 2.47, confidence interval 95% 1.65 - 3.71, p < 0.001) were associated with acute heart failure. Obesity, atrial fibrillation, peripheral artery disease and chronic kidney disease were identified as independent risk factors. Patients with multiple comorbidities had a superior risk of hospitalization due to heart failure: zero comorbidities – odds ratio 0.43, 95% confidence interval 0.28 - 0.67, p < 0.001; one comorbidity – odds ratio 0.69, 95% confidence interval 0.47 - 1.01, p = 0.057; two comorbidities – odds ratio 1.85, 95% confidence interval 1.11 - 3.08, p = 0.019; ≥ three comorbidities – odds ratio 5.81, 95% confidence interval 2.77 - 12.16, p < 0.001.Discussion: This study shows an association between several comorbidities and hospital admission due to acute heart failure. The association seems to strengthen in the presence of multiple comorbidities.Conclusion: A comorbidome is a useful tool to identify comorbidities associated with higher risk of acute heart failure. The identification of vulnerable patients may allow multidimensional interventions to minimize future hospital admissions.

scholarly journals Independent predictors of heart failure in patients with type 2 diabetes and chronic kidney disease: modeling from the CREDENCE trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K.W Mahaffey ◽  
J Li ◽  
T.I Chang ◽  
A Sarraju ◽  
R Agarwal ◽  
...  
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Estimated Glomerular Filtration Rate ◽  
Disease Modeling ◽  
Funding Source ◽  
Private Company ◽  
Potent Predictor

Abstract Background SGLT2 inhibitors have been shown to reduce hospitalization for heart failure (HHF). We sought to determine independent baseline predictors for HHF specifically in a population with type 2 diabetes and chronic kidney disease (CKD). Methods CREDENCE randomized 4401 participants with type 2 diabetes and CKD to canagliflozin 100 mg versus placebo. We evaluated the baseline clinical and demographic factors using multivariate regression modeling to identify the independent predictors of HHF. Results Overall, 230 participants (89 canagliflozin; 141 placebo) had at least 1 HHF event. Canagliflozin reduced the incidence of HHF compared with placebo (4.0% vs 6.4%; HR 0.61; 95% CI 0.47–0.80). Participants with HHF events postrandomization were older (65.8 vs 62.9 y), and had a longer duration of diabetes (17.4 vs 15.7 y), higher prevalence of prior HF (30.4% vs 14.0%), higher urinary albumin:creatinine ratio (1347 vs 904 mg/g), lower estimated glomerular filtration rate (51.5 vs 56.4 mL/min/1.73m2), and higher prevalence of prior cardiovascular disease (65.7% vs 49.6%) compared to those without HHF. Independent predictors of HHF are shown in the Table. Conclusions HHF is common in patients with type 2 diabetes and CKD. Canagliflozin reduces HHF by 39% compared with placebo. Higher urinary albumin:creatinine ratio was the most potent predictor of HHF and should be part of patient risk assessment. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Janssen Research & Development, LLC

scholarly journals Risk Factors and Comorbidities Associated with Diabetic Kidney Disease

2021 ◽  
Vol 12 ◽  
pp. 215013272110485
Author(s):  
Satyajeet Roy ◽  
Olga Schweiker-Kahn ◽  
Behjath Jafry ◽  
Rachel Masel-Miller ◽  
Riya Sam Raju ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Coronary Artery Disease ◽  
Congestive Heart Failure ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Peripheral Artery ◽  
Cerebrovascular Accidents ◽  
Patients With Diabetes ◽  
Artery Disease

Introduction/objectives: Diabetic Kidney Disease (DKD) is the leading cause of end-stage kidney disease. Despite optimal glycemic control and blood pressure management, progression to DKD cannot be halted in some patients. We aimed to find the association of modifiable and non-modifiable risk factors and comorbid conditions in patients with DKD. Methods: Retrospective medical record review of adult patients with diabetes mellitus (DM) was performed who visited our internal medicine office between January 1, 2020 and December 31, 2020. Results: Among 728 patients with DM, 471 (64.7%) patients had DKD, and 257 (35.3%) patients were without DKD. Among the group of patients with DKD, the majority were in CKD stage G1A2 (34.6%), followed equally by G2A2 and G3aA1 (16.8% each). Mean age of the patients with DKD was significantly greater than the patients without DKD (69.4 years vs 62.2 years; P < .001). For each unit increase in age, there was a 7.8% increase in the odds of DKD (95% CI 5.3-10.4; P < .001). Women had 2.32 times greater odds of DKD (95% CI, 1.41-3.81; P = .001). We found decreased odds of DKD for those who consumed alcohol moderately (OR 0.612, 95% CI 0.377-0.994; P < .05). Significantly higher frequencies of associations of several comorbid medical conditions were seen in patients with DKD compared to the patients without DKD, such as hypertension (91.9% vs 75.6%), hyperlipidemia (86.6% vs 78.2%), coronary artery disease (39.3% vs 16.8%), cerebrovascular accidents (13.4% vs 7.4%), congestive heart failure (12.9% vs 4.1%), carotid artery stenosis (11.3% vs 2.6%), aortic aneurysm (5.4% vs 2.0%), peripheral artery disease (10.8% vs 3.5%), gout (12.4% vs 5.5%), and osteoarthritis (41.4% vs 31.2%). Conclusions: In patients with diabetes, increasing age, female sex, and lack of moderate alcohol consumption were associated with increased odds of DKD. Higher frequencies of association of hypertension, hyperlipidemia, coronary artery disease, cerebrovascular accidents, congestive heart failure, carotid artery stenosis, aortic aneurysm, peripheral artery disease, gout, and osteoarthritis were also seen in patients with DKD.

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