{
  "abstract": "In this issue, Toma et al report findings from the FOCUS-PAH cohort, an international registry of 555 incident pulmonary arterial hypertension (PAH) patients diagnosed between 2001 and 2023.1 Among them, 234 (42%) met criteria for renal-diabetic (RD) overlap, defined by the presence of chronic kidney disease (CKD) and/or diabetes mellitus (DM), 45 with DM alone, 135 with CKD alone and 54 with both. Compared with non-RD patients, those with RD overlap were older and carried a higher comorbidity burden, including more connective-tissue disease-associated PAH, systemic hypertension and atrial fibrillation. They also exhibited a more severe clinical profile at baseline: shorter 6-min walk distance (294 vs 360 m, p<0.001), worse WHO functional class, higher NT-proBNP and pulmonary artery wedge pressure (PAWP) and echocardiographic features suggestive of subclinical left heart disease (higher E/e′, left atrial volume index and right atrial area). At baseline, a significantly higher proportion of patients were classified at high risk (of death within a year): 36% vs 26% of non-RD patients (p<0.01). Despite similar therapeutic escalation at follow-up, 19% and 32% of RD patients remained at high or intermediate-high risk, respectively, versus 4% and 23% of non-RD patients (p<0.001), and 6MWD improved only in the non-RD group. Over a median follow-up of 2.5 years, RD overlap was independently associated with worse outcomes: HR 1.45 (95% CI 1.07 to 1.98, p=0.02) for the composite of all-cause mortality or PAH-related hospitalisation and HR 1.47 (95% CI 1.05 to 2.04, p=0.02) for all-cause mortality alone.",
  "authors": [
    {
      "affiliations": [
        "Cardiology, University Hospital Centre Rouen, Rouen, France",
        "Inserm EnVI U1096, FHU CARNAVAL, University of Rouen Normandy, Rouen, France"
      ],
      "name": "Charles Fauvel"
    },
    {
      "affiliations": [
        "Centre d'Investigations Cliniques Plurithématique 1433, CHRU de Nancy, Nancy, France",
        "Inserm U1116, Université de Lorraine, Nancy, France",
        "INI-CRCT, F-CRIN, Nancy, France",
        "REICATRA, Vandœuvre-lès-Nancy, France"
      ],
      "name": "Guillaume Baudry"
    }
  ],
  "title": "Renal-diabetic overlap in pulmonary arterial hypertension: a vulnerable phenotype at the crossroads of comorbidity and vascular pathobiology",
  "uid": "c0a1f9bd-d938-5a07-944a-4e37f971a8f4"
}