Two-Year Changes in Diabetic Kidney Disease Phenotype and the Risk of Heart Failure: A Nationwide Population-Based Study in Korea

Background: Diabetic kidney disease (DKD) is a risk factor for hospitalization for heart failure (HHF). DKD could be classified into four phenotypes by estimated glomerular filtration rate (eGFR, normal vs. low) and proteinuria (PU, negative vs. positive). Also, the phenotype often changes dynamically. This study examined HHF risk according to the DKD phenotype changes across 2-year assessments. Methods: The study included 1,343,116 patients with type 2 diabetes mellitus (T2DM) from the Korean National Health Insur-ance Service database after excluding a very high-risk phenotype (eGFR <30 mL/min/1.73 m2) at baseline, who underwent two cycles of medical checkups between 2009 and 2014. From the baseline and 2-year eGFR and PU results, participants were divided into 10 DKD phenotypic change categories.Results: During an average of 6.5 years of follow-up, 7,874 subjects developed HHF. The cumulative incidence of HHF from in-dex date was highest in the eGFRlowPU- phenotype, followed by eGFRnorPU+ and eGFRnorPU-. Changes in DKD phenotype differ-ently affect HHF risk. When the persistent eGFRnorPU- category was the reference, hazard ratios for HHF were 3.10 (95% confi-dence interval [CI], 2.73 to 3.52) in persistent eGFRnorPU+ and 1.86 (95% CI, 1.73 to 1.99) in persistent eGFRlowPU-. Among al-tered phenotypes, the category converted to eGFRlowPU+ showed the highest risk. In the normal eGFR category at the second ex-amination, those who converted from PU- to PU+ showed a higher risk of HHF than those who converted from PU+ to PU-.Conclusion: Changes in DKD phenotype, particularly with the presence of PU, are more likely to reflect the risk of HHF, com-pared with DKD phenotype based on a single time point in patients with T2DM.

Automated summary

This study examined the changes in diabetic kidney disease (DKD) phenotypes over a 2-year period and found that these changes were associated with the risk of hospitalization for heart failure (HHF). The presence of proteinuria (PU) was particularly predictive of HHF risk.