Heart failure hospitalisation relative to major atherosclerotic events in type 2 diabetes with versus without chronic kidney disease: A meta-analysis of cardiovascular outcomes trials

Aim: We examined whether chronic kidney disease (CKD) modifies the frequency of heart failure hospitalisation (HHF) relative to atherosclerotic major adverse cardiovascular events (MACE; composite of cardiovascular death, myocardial infarction [MI], or stroke) in people with type 2 diabetes. Methods: Of 16 cardiovascular outcomes trials in type 2 diabetes since 2013, seven reported outcomes stratified by estimated glomerular filtration rate (eGFR) category (<60 vs. ≥60 mL/min/1.73 m²), and five by albuminuria status. Placebo-arm incidence rates of HHF, MACE, MI and stroke were extracted for each eGFR and albuminuria subgroup. Results: CKD coincided with higher rates of all events, but the greatest increase was observed for HHF (2.66 times higher rate in subgroups with reduced eGFR [95% CI 2.23–3.18]; 2.69 times higher in those with albuminuria [95% CI 2.30–3.13]). By contrast, the rate of MACE was 1.78 (1.67–1.91) and 1.80 (1.57–2.07) times higher in those with reduced eGFR and albuminuria, respectively. In people with CKD, HHF occurred at a similar rate to MI (ratio of HHF:MI = 0.92 with eGFR <60, 0.94 with albuminuria), while in those without CKD, MI was significantly more common (HHF:MI = 0.58 with eGFR 60+ and 0.60 with normoalbuminuria). HHF rates exceeded stroke in people with CKD, but these events otherwise occurred at a similar rate. While reduced eGFR was associated with older age, no such differences between people with/without albuminuria explained their different event profile. Conclusion: CKD is associated with a shift in the profile of cardiovascular events in people with type 2 diabetes, marked by a disproportionate increase in HHF relative to MACE.