Rapid kidney function decline and increased risk of heart failure in patients with type 2 diabetes: findings from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) cohort : Rapid kidney function decline and heart failure in T2D
Authors' conclusion
In patients with T2D, rapid kidney function decline is associated with a marked increase in HF risk, independent of starting kidney function and/or albuminuria. These findings highlight the importance of serial eGFR measurements over time to improve HF risk estimation in T2D.
Study context
- Population
- ACCORD participants with T2D, baseline urinary albumin-to-creatinine ratio (UACR) data, completed 4 years of follow-up and ≥ 3 eGFR measurements
- Participants
- 7,539 participants
- Comparison
- Rapid kidney function decline vs no rapid decline
- Rapid declinen = 1,573
- Primary endpoint
- HF hospitalization or HF death
- Follow-up
- First 4 years
Methodological detailscohort
- Cohort
Primary result
As reported in the abstract
4 years
Rapid decline vs No rapid declineEstimate (95% CI)P value
Independent of baseline CVD history
OR 3.23(2.51–4.16)
P < 0.0001Adjusted incl. eGFR and UACR at baseline and at censoring
adjusted OR 3.74(2.63–5.31)
- Experienced heart failure (HF) event (overall)
- 255 (3.4%)
Further findings
Added discrimination of rapid decline over WATCH-DM score, eGFR and UACR at entry and end of follow-up
- ROC AUC increment
- + 0.02, p = 0.027
- Relative integrated discrimination improvement (IDI)
- + 38%, p < 0.0001
Rapid kidney function decline (incidence) · 4 years
- Experienced rapid kidney function decline
- 1,573 (20.9%)
Original publication
Rapid kidney function decline and increased risk of heart failure in patients with type 2 diabetes: findings from the ACCORD cohort : Rapid kidney function decline and heart failure in T2D. Cardiovasc Diabetol. Published 26 June 2023. doi:10.
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