{"id":"c6aeb7d110d9","type":"article","url":"https://hartvaat.nl/2026/05/25/pah-met-renaal-diabetische-overlap-komt-vaak-voor-en-geeft-tweemaal-zo-hoog-mort/","title":"PAH met renaal-diabetische overlap komt vaak voor en geeft tweemaal zo hoog mortaliteitsrisico","title_en":"","category":"chronische nierziekte","category_label":"Nierziekte","professions":["cardioloog","internist"],"tags":["anemie-ckd","cardio-renaal-metabool","diabetes-en-hart","fidelio-dkd","figaro-dkd","soul-trial"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2025-327389","source_url":"https://doi.org/10.1136/heartjnl-2025-327389","authors":["Matteo Toma","Suela Vani","Giulio Savonitto","Francesca Coppi","Andrea Garascia","Alberto Giannoni","Clara Hjalmarsson","Francesco Lo Giudice","Carlo Lombardi","Claudia Raineri","Matteo Rugolotto","Laura Scelsi","Marco Metra","Luke Howard","Gianfranco Sinagra","Italo Porto","Davide Stolfo","Pietro Ameri"],"significance":6,"published":"2026-06-01","source_date":"2026-05-25","image":"https://hartvaat.nl/global/img/737cbe5a1f5d.webp","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/nierziekte/nsaids-en-nierziekte/"],"congress":"","summary_en":"Retrospective international cohort of 555 incident PAH patients (diagnosed 2001-2023). 42% (n=234) had chronic kidney disease and/or diabetes (renal-diabetic, RD): 45 DM only, 135 CKD only, 54 both. RD patients were older, had greater comorbidity burden, worse WHO functional class and higher pulmonary artery wedge pressure. At PAH diagnosis, RD patients were less often treated with endothelin receptor antagonists (61% vs 69%) and more often with single-agent therapy (55% vs 45%). Over 2.5 years of follow-up, the composite of death or PAH hospitalisation was significantly higher in RD (HR 1.45; 95% CI 1.07-1.98), as was all-cause mortality (HR 1.47). PAH with renal-diabetic overlap is common, under-treated and prognostically worse.","created":"2026-07-03T10:32:59Z","updated":"2026-07-03T13:31:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Retrospectieve internationale cohortstudie van 555 incident PAH-patiënten (diagnose 2001-2023). 42% (n=234) had chronische nierziekte en/of diabetes (renaal-diabetisch, RD): 45 alleen DM, 135 alleen CKD en 54 beide. RD-patiënten waren ouder, hadden een hogere comorbiditeitslast, slechtere WHO-functieklasse en hogere pulmonale wig-druk. Bij PAH-diagnose werden RD-patiënten minder vaak met endotheline-receptor-antagonisten (61% vs 69%) en vaker met monotherapie behandeld (55% vs 45%). Over 2,5 jaar follow-up was de samengestelde uitkomst van overlijden of PAH-opname significant hoger bij RD (HR 1,45; 95%-BI 1,07-1,98), evenals de totale mortaliteit (HR 1,47). PAH met RD-overlap is dus klinisch frequent, ondertherapie-gevoelig en prognostisch slechter.","abstract_original":"BACKGROUND: Comorbidities add complexity to pulmonary arterial hypertension (PAH), but also open opportunities to use therapies with benefits beyond the cardiovascular (CV) system, particularly preserving renal function and maintaining glucose homeostasis. METHODS: We retrospectively analysed an international cohort of incident patients with PAH diagnosed in 2001-2023, with available outcome data. Patients with chronic kidney disease (CKD) and/or diabetes mellitus (DM) were defined as renal-diabetic (RD). The relationship between RD overlap, all-cause mortality (ACM) or PAH hospitalisation or ACM alone was assessed by Kaplan-Meier curves and Cox proportional hazard regression. RESULTS: Of 555 eligible subjects, 234 (42%) were classified as RD: 45 had DM, 135 CKD and 54 both. At baseline, RD patients were older and had greater comorbidity burden, higher WHO functional class and higher pulmonary artery wedge pressure than non-RD patients; 36% vs 26% (p<0.01) were estimated at high mortality risk. On PAH diagnosis, RD patients were less treated with endothelin receptor antagonists (61% vs 69%, p=0.04) and more with single PAH therapy (55% vs 45%, p=0.06). After 9 months, treatment patterns were similar, but 19% and 32% of RD patients were at high or intermediate-high risk, respectively, as compared with 4% and 23% of non-RD patients (p<0.001).During a follow-up of 2.5 (1-5) years, ACM/PAH hospitalisation and ACM alone were more frequent in RD patients than non-RD patients, with HR 1.45 (95% CI 1.07 to 1.98, p=0.02) and HR 1.47 (95% CI 1.05 to 2.04, p=0.02), respectively. CONCLUSION: PAH with RD overlap is common, and has unmet therapeutic needs and worse outcomes."}