Impact of diabetes on cardiovascular outcomes in hemodialysis patients undergoing coronary revascularization.

Abstract

BACKGROUND:

Among hemodialysis (HD) patients, those who have diabetes have poorer cardiovascular outcomes than non-diabetic patients, but the impact of diabetes on cardiovascular outcomes has not been fully elucidated in HD patients undergoing coronary revascularization.

METHODS AND RESULTS:

We identified 375 HD patients (203 diabetes, 172 non-diabetes) and 9,006 patients without HD (3,455 diabetes, 5,551 non-diabetes) in the database of the CREDO-Kyoto registry of patients undergoing their first coronary revascularization. In non-HD patients, significantly higher risks of death (10.8% vs. 7.7%, P < 0.0001; adjusted hazard ratio (HR) 1.29, P < 0.0001) and major adverse cardiovascular events (MACE), a composite of death, myocardial infarction and stroke (18.8% vs. 13.3%, P < 0.0001; HR 1.36, P < 0.0001) were seen in diabetic patients than in non-diabetic patients through 4-year follow-up. Analysis in HD patients showed that the duration of HD before first coronary revascularization was significantly shorter in diabetic patients than in non-diabetic patients (median interval: 858 vs. 2,216 days, P < 0.0001). In contrast to the results in non-HD patients, the risks of death (41.9% vs. 39.1%, P=0.75; HR 0.98, P=0.93) and MACE (45.6% vs. 45.8%, P=0.83; HR 0.87, P=0.50) after first revascularization were comparable between diabetic and non-diabetic HD patients. There were significant interactions between HD and diabetes for death and for MACE.

CONCLUSIONS:

HD patients who require coronary revascularization have extremely poor outcomes irrespective of concomitant diabetes.

• Authors: Masahiro Natsuaki, Yutaka Furukawa, Takeshi Morimoto, Yoshihisa Nakagawa, Masaharu Akao, Koh Ono, Tetsuo Shioi, Satoshi Shizuta, Ryuzo Sakata, Hitoshi Okabayashi, Noboru Nishiwaki, Tatsuhiko Komiya, Satoru Suwa, Takeshi Kimura
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 75 Issue 7 Pg. 1616-25 ( 2011) ISSN: 1347-4820 [Electronic] Japan
• PMID: 21532182 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Angioplasty, Balloon, Coronary
• Cohort Studies
• Comorbidity
• Coronary Artery Bypass
• Coronary Artery Disease (epidemiology, mortality, therapy)
• Diabetes Complications (complications, epidemiology)
• Female
• Follow-Up Studies
• Humans
• Japan
• Kidney Diseases (epidemiology, therapy)
• Longitudinal Studies
• Male
• Middle Aged
• Myocardial Infarction (epidemiology, prevention & control)
• Prognosis
• Registries
• Renal Dialysis
• Retrospective Studies
• Risk Factors
• Stroke (epidemiology, prevention & control)
• Survival Rate
• Treatment Outcome