The relationship between eGFR and hospitalization for heart failure in 54,486 individuals with type 2 diabetes

Journal article, 2016

BACKGROUND: To study the association between renal function and hospitalization for heart failure (HF) in individuals with type 2 diabetes. METHODS: Renal function was determined according to 3 formulas used to estimate glomerular filtration rate (eGFR): Cockcroft-Gault, Modified Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology (CKD-EPI). Proportional hazards regression models adjusted for age, sex, HbA1c, blood pressure, smoking, and cardiovascular comorbidities were constructed for each eGFR formula to estimate risk of HF hospitalization. RESULTS: In 54,486 patients, using Cockcroft-Gault, 41% were categorized as having normal renal function (eGFR > 90 ml/min), compared to 22.9% using MDRD and 21.6% using CKD-EPI. In the cohort, there were 21%-24% (depending on eGFR formula) with eGFR < 60 ml/min of whom 1.0%-1.5% had eGFR < 30 ml/min. Over a median follow-up of 7.0 years, a total of 5936 (10.9%) developed heart failure, with an excess risk in all eGFR categories below 60 ml/min/1.73 m2 (reference: eGFR > 90 ml/min/1.73 m2). Hazard ratios (HRs) ranged from 1.25 to 1.35 for eGFR 45-60 ml/min/1.73 m2,1.62 to 1.66 for eGFR 30-45 ml/min/1.73 m2, and 2.18 to 2.52 for eGFR <30 ml/min/1.73 m2 in the three eGFR formulas. CONCLUSIONS: Patients with type 2 diabetes, with eGFR 45 to 60 ml/min/1.73 m2 , have approximately 25%-35% increased risk of hospitalization for HF, increasing with lower eGFR, to 2-2.5 times in those with eGFR <30 ml/min/1.73 m2.