by Prateek Chopra | May 18, 2026 | Cardiology Conferences | ESC-HF 2026
Type 2 Diabetes Mellitus (T2DM) and Chronic Kidney Disease (CKD) frequently coexist with Heart Failure (HF), substantially increasing the risks of mortality and hospitalization for HF (HHF). Several HF therapies have demonstrated cardiorenal benefits in patients with CKD and/or T2DM; however, real-world evidence suggests that these therapies remain underutilized and are frequently discontinued. This study aimed to evaluate the prevalence of T2DM and CKD across ejection fraction (EF) categories, assess HF medication use, particularly Mineralocorticoid Receptor Antagonists (MRA), and determine cause-specific event rates and multivariable-adjusted risks for death, HHF, and end-stage renal disease (ESRD). The findings were presented at Heart Failure 2026, organized by the European Society of Cardiology, held in Barcelona, Spain, from 9–12 May 2026.
Adult patients enrolled in the Swedish HF registry between 2017 and 2023, excluding those on dialysis or with missing EF or renal function data, were categorized into four groups: no CKD/no T2DM, CKD only, T2DM only, and both CKD/T2DM. HF medication use and risks of cardiovascular death, first HHF, their composite, all-cause death, and ESRD event rates and risks were assessed overall and by EF.
Among 54,324 patients (34% women; mean age 73 years), 52% had HFrEF, 26% HFmrEF, and 21% HFpEF. Overall, 24% had CKD only, 14% T2DM only, and 11% both CKD/T2DM. CKD, alone or combined with T2DM, was more prevalent in HFpEF than in HFmrEF or HFrEF (p<0.001). Patients with CKD and/or T2DM were generally older, more frequently female, and had worse HF symptoms. MRA use ranged from 48%–64% in HFrEF, 36%–46% in HFmrEF, and 25%–42% in HFpEF, with lower use observed in HFrEF patients with CKD. Adjusted hazard ratios for HF/cardiovascular death were 1.40 for CKD alone and 1.72 for combined CKD/T2DM. For mortality and HHF outcomes, adjusted HRs ranged from 1.26–1.33 for T2DM alone, 1.40–1.56 for CKD alone, and 1.70–1.80 for combined CKD/T2DM. While T2DM alone did not significantly increase ESRD risk, CKD alone and combined CKD/T2DM markedly increased ESRD risk, with adjusted HRs of 3.04 and 5.74, respectively.
T2DM and CKD were highly prevalent across the HF spectrum, particularly in HFpEF, and were associated with worse cardiovascular and renal outcomes. CKD emerged as a strong independent risk factor for mortality, HHF, and ESRD, while combined CKD/T2DM conferred the greatest overall risk burden. CKD was also associated with lower MRA use in HFrEF, highlighting the need for improved implementation of guideline-directed HF therapies in high-risk cardiorenal populations.