Impact of type 2 diabetes on the relationship between chronic kidney disease and cardiovascular outcomes in heart failure across ejection fraction: observational study from the Swedish heart failure and the Swedish National diabetes registries
Authors' conclusion
In a contemporary HF cohort, decreased kidney function was associated with a progressively higher risk of HHF/CV death, and T2D was not a risk modifier. Renal protection should therefore be implemented in HF regardless of T2D.
Study context
- Population
- Heart failure (HF) patients in the Swedish Heart Failure Registry, January 2017 to December 2021; 8,053 (22%) with T2D; 53%, 25%, 22% HF with reduced, mildly-reduced and preserved ejection fraction (EF)
- Participants
- 36,597 patients
- Exposure
- eGFR categories in HF patients with vs without T2D
- eGFR ≥ 60n = 23,562
- eGFR 45-59n = 7,122
- eGFR 30-44n = 4,477
- eGFR < 30n = 1,436
- Outcome
- Composite of:
- Time to first HF hospitalization (HHF)
- CV death
Methodological detailsobservational, linkage of Swedish Heart Failure Registry and National Diabetes Registry, multivariable Cox regression with interaction testing, subgroup analysis by EF
- Observational
- Linkage of Swedish Heart Failure Registry and National Diabetes Registry
- Multivariable Cox regression with interaction testing
- Subgroup analysis by EF
Main finding
As reported in the abstract
HHF or CV death by eGFR category, according to T2D
- Consistent across EF, except HFpEF with eGFR < 30 ml/min/1.73 m²: association smaller in T2D than non-T2D
- p-interaction < 0.01
Observational data: associations, not effects.
Secondary outcomes
Major adverse CV events (MACE), cardiovascular (CV) death and all-cause mortality by eGFR category
- Risks higher for lower eGFR categories, with lower hazards in T2D group
- P for interaction < 0.01
Baseline characteristics by T2D
- Across eGFR, patients with vs without T2D were younger, more often male, with higher CV comorbidity and more frequent use of cardio-renal drugs
- Across EF categories, T2D patients had higher prevalence of chronic kidney disease (CKD)
Original publication
Impact of type 2 diabetes on the relationship between chronic kidney disease and cardiovascular outcomes in heart failure across ejection fraction: observational study from the Swedish heart failure and the Swedish National diabetes registries. Cardiovasc Diabetol. Published 1 December 2025. doi:10.
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