Impaired kidney function and albuminuria are associated with increased risk of heart failure (HF) in patients with type 2 diabetes (T2D). We investigated whether rapid kidney function decline over time is an additional determinant of increased HF risk in patients with T2D. We further assessed whether accounting for the rate of estimated glomerular filtration rate (eGFR) decline over time improved prediction of HF risk as compared to standard clinical predictors. Included in the study were 9,192 participants in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study with available baseline urinary albumin-to-creatinine ratio (UACR) data and ≥3 eGFR measurements during follow-up. The association between rapid kidney function decline (eGFR loss ≥5 ml/min/1.73 m2/year) and odds of HF hospitalization or HF death during follow-up was estimated by logistic regression. We calculated integrated discrimination improvement (IDI) by adding rapid kidney function decline to HF predictors. Over a median follow-up of 5.0 years (interquartile range 4.1-5.7), 1,432 participants (15.6%) experienced rapid kidney function decline and 355 (3.9%) experienced a HF event. Rapid kidney function decline was associated with a 3.57-fold increase in HF odds (odds ratio [OR] 3.57; 95% confidence interval [CI] 2.86-4.45). This estimate was not attenuated by adjustment for potential confounders, including eGFR and UACR at baseline and censoring (OR 4.47; 95% CI 3.7-6.11). Adding rapid kidney function decline during follow-up to other predictors (WATCH-DM score, eGFR, and UACR) significantly improved HF risk classification (relative IDI=+49%, p<0.0001). In patients with T2D, rapid kidney function decline was 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 prediction in patients with T2D.


A.Bano: None. C.Bueno junior: None. Y.Tang: None. X.Sun: None. E.Hall: None. J.Mitri: Other Relationship; Novo Nordisk, Research Support; Kowa Company, Ltd. M.Morieri: Advisory Panel; Merck Sharp & Dohme Corp., Amarin Corporation, Servier Laboratories, Speaker's Bureau; Eli Lilly and Company, Novo Nordisk. H.Shah: None. A.Doria: None.


National Heart, Lung, and Blood Institute (N01HC95178, N01HC95179, N01HC95180, N01HC95181, N01HC95182, N01HC95183, N01HC95184, IAAY1HC-9035, IAAY1HC1010); National Institute of Diabetes and Digestive and Kidney Diseases; National Institute on Aging; National Eye Institute; Centers for Disease Control and Prevention; General Clinical Research Centers

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