Manifestation of Heart Failure and Chronic Kidney Disease are Associated with Increased Mortality Risk in Early Stages of Type 2 Diabetes Mellitus: Analysis of a Japanese Real-World Hospital Claims Database

Takashi Kadowaki; Issei Komuro; Naru Morita; Hiroki Akiyama; Yoko Kidani; Toshitaka Yajima

doi:10.1007/s13300-021-01191-y

Manifestation of Heart Failure and Chronic Kidney Disease are Associated with Increased Mortality Risk in Early Stages of Type 2 Diabetes Mellitus: Analysis of a Japanese Real-World Hospital Claims Database

Diabetes Ther. 2022 Feb;13(2):275-286. doi: 10.1007/s13300-021-01191-y. Epub 2022 Jan 10.

Authors

Takashi Kadowaki¹, Issei Komuro², Naru Morita³, Hiroki Akiyama³, Yoko Kidani³, Toshitaka Yajima⁴

Affiliations

¹ Toranomon Hospital, Tokyo, Japan.
² Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
³ Cardiovascular, Renal, and Metabolism, Medical Affairs, AstraZeneca K.K., Tower B Grand Front Osaka, 3-1 Ofukacho, Kita-ku, Osaka, 530-0011, Japan.
⁴ Cardiovascular, Renal, and Metabolism, Medical Affairs, AstraZeneca K.K., Tower B Grand Front Osaka, 3-1 Ofukacho, Kita-ku, Osaka, 530-0011, Japan. toshitaka.yajima@astrazeneca.com.

Abstract

Introduction: To assess the initial manifestation of comorbidities and their impact on mortality risk in patients with type 2 diabetes mellitus (T2DM) without a history of cardiovascular or renal complications (i.e., in the early stages of T2DM) compared with patients without T2DM.

Methods: We performed a retrospective cohort study using a Japanese hospital claims database. The incidence rates of comorbidities (chronic kidney disease [CKD], heart failure [HF], myocardial infarction [MI], peripheral arterial disease [PAD], and stroke) and mortality risk were compared between patients with T2DM and age-/sex-matched patients without T2DM (matched 1:2).

Results: Among the comorbidities assessed in this study, CKD and/or HF was the most frequent initial manifestation in the patients with T2DM (n = 426,186) with an incidence rate 2.02 times greater than that in matched patients without T2DM (n = 1,018,609). The mortality risk was also greater in patients with T2DM than in patients without T2DM with a hazard ratio of 1.73. In both patients with and without T2DM, the presence of CKD or HF was associated with greater mortality risks compared with the presence of MI, PAD, or stroke.

Conclusions: The high incidence of CKD or HF manifestation can contribute to the augmented mortality risk in patients in the early stages of T2DM compared with patients without T2DM. These findings highlight the importance of early interventions for preventing/treating CKD and HF to improve the prognosis of patients with T2DM.

Keywords: Cardiorenal syndrome; Chronic kidney disease; Complications; Diabetes; Heart failure; Real-world data.