{
  "abstract": "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.",
  "authors": [
    {
      "affiliations": [
        "Cardiovascular Disease Unit, IRCCS Azienda Ospedaliera Metropolitana, Genova, Italy"
      ],
      "name": "Matteo Toma"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, University of Genova, Genova, Italy"
      ],
      "name": "Suela Vani"
    },
    {
      "affiliations": [
        "Cardiothoracovascular Department, Trieste University Integrated Health Authority, Trieste, Italy"
      ],
      "name": "Giulio Savonitto"
    },
    {
      "affiliations": [
        "Cardiology Division, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy"
      ],
      "name": "Francesca Coppi"
    },
    {
      "affiliations": [
        "Niguarda Hospital, Milan, Italy"
      ],
      "name": "Andrea Garascia"
    },
    {
      "affiliations": [
        "Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica, Pisa, Italy"
      ],
      "name": "Alberto Giannoni"
    },
    {
      "affiliations": [
        "Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden"
      ],
      "name": "Clara Hjalmarsson"
    },
    {
      "affiliations": [
        "National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK",
        "Imperial College NHS Trust, London, UK"
      ],
      "name": "Francesco Lo Giudice"
    },
    {
      "affiliations": [
        "Experimental and clinical medicine, University of Brescia, Brescia, Italy"
      ],
      "name": "Carlo Lombardi"
    },
    {
      "affiliations": [
        "Cardiovascular and Thoracic Department, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy"
      ],
      "name": "Claudia Raineri"
    },
    {
      "affiliations": [
        "Department Of Cardiology, Ca’foncella Hospital, Treviso, Italy"
      ],
      "name": "Matteo Rugolotto"
    },
    {
      "affiliations": [
        "Cardiac, Thoracic and Vascular Department, Fondazione IRCCS, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy"
      ],
      "name": "Laura Scelsi"
    },
    {
      "affiliations": [
        "Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy",
        "University of Brescia Department of Medical-Surgical Specialties Radiological Sciences and Public Health, Brescia, Italy"
      ],
      "name": "Marco Metra"
    },
    {
      "affiliations": [
        "Pulmonary Hypertension, Imperial College Healthcare NHS Trust, London, UK"
      ],
      "name": "Luke Howard"
    },
    {
      "affiliations": [
        "Cardiovascular Department, Azienda sanitaria universitaria Giuliano Isontina, Trieste, Italy"
      ],
      "name": "Gianfranco Sinagra"
    },
    {
      "affiliations": [
        "Cardiovascular Disease Unit, IRCCS Azienda Ospedaliera Metropolitana, Genova, Italy",
        "Department of Internal Medicine, University of Genova, Genova, Italy"
      ],
      "name": "Italo Porto"
    },
    {
      "affiliations": [
        "Department of Medicine Clinical Science and Education, Södersjukhuset Karolinska Institute, Stockholm, Sweden",
        "Cardiology, Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy"
      ],
      "name": "Davide Stolfo"
    },
    {
      "affiliations": [
        "Cardiovascular Disease Unit, IRCCS Azienda Ospedaliera Metropolitana, Genova, Italy",
        "Department of Internal Medicine, University of Genova, Genova, Italy"
      ],
      "name": "Pietro Ameri"
    }
  ],
  "title": "Renal-diabetic overlap in pulmonary arterial hypertension",
  "uid": "c244137a-595d-5dfc-b6cc-66a9d915c1e0"
}