Decreased kidney function independently worsens outcomes in HF, regardless of T2DM status. A large cohort analysis published in Cardiovascular Diabetology evaluated whether T2DM influences the association between renal impairment and cardiovascular complications in HF.

The study included 36,597 adults from the Swedish Heart Failure Registry between 2017 and 2021. Patients were stratified by T2DM status and eGFR categories: ≥60, 45–59, 30–44, and <30 mL/min/1.73 m². The primary outcome was time to first HF hospitalization or cardiovascular death. Secondary outcomes included major adverse cardiovascular events, cardiovascular death, and all-cause mortality.

Of the total cohort, 8,053 individuals (22%) had T2DM. Progressively lower eGFR categories were associated with higher risk of all outcomes, and this pattern remained consistent in both T2DM and non-T2DM groups. Across ejection fraction subtypes, the association was similar, except in HF with preserved ejection fraction and severe kidney dysfunction (eGFR <30 mL/min/1.73 m²) where the risk increase was attenuated in T2DM (interaction P <0.01).

These findings demonstrate that impaired kidney function is a strong and independent driver of poor prognosis in HF. Renal protective strategies should be prioritized in HF management across the entire spectrum of T2DM status.