Cardiac disease in diabetic end-stage renal disease

Little is known about the epidemiology of cardiac disease in diabetic end-stage renal disease. We therefore prospectively followed a cohort of 433 patients who survived 6 months after the inception of dialysis therapy for an average of 41 months. Clinical and echocardiographic data were collected ye...

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Bibliographic Details
Published in:Diabetologia 1997-11, Vol.40 (11), p.1307-1312
Main Authors: Foley, R N, Culleton, B F, Parfrey, P S, Harnett, J D, Kent, G M, Murray, D C, Barre, P E
Format: Article
Language:English
Subjects:
Adult
Aged
Cardiomyopathy
Cardiovascular disease
Cardiovascular diseases
Cohort Studies
Coronary artery disease
Diabetes
Diabetes mellitus
Diabetic Nephropathies - diagnosis
Diabetic Nephropathies - epidemiology
Diabetic Nephropathies - mortality
Dialysis
End-stage renal disease
Epidemiology
Female
Heart
Heart diseases
Heart Diseases - diagnosis
Heart Diseases - epidemiology
Heart Diseases - mortality
Humans
Hypertrophy
Ischemia
Kidney diseases
Kidney Failure, Chronic - diagnosis
Kidney Failure, Chronic - epidemiology
Kidney Failure, Chronic - mortality
Male
Middle Aged
Morbidity
Mortality
Prognosis
Prospective Studies
Renal Replacement Therapy
Risk Factors
Smoking
Ventricle
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Summary:Little is known about the epidemiology of cardiac disease in diabetic end-stage renal disease. We therefore prospectively followed a cohort of 433 patients who survived 6 months after the inception of dialysis therapy for an average of 41 months. Clinical and echocardiographic data were collected yearly. At baseline, diabetic patients (n = 116) had more echocardiographic concentric left ventricular hypertrophy (50 vs 38%, p = 0.04), clinically diagnosed ischaemic heart disease (32 vs 18%, p = 0.003) and cardiac failure (48 vs 24%, p < 0.00001) than non-diabetic patients (n = 317). After adjusting for age and sex, diabetic patients had similar rates of progression of echocardiographic disorders, and de novo cardiac failure, but higher rates of de novo clinically diagnosed ischaemic heart disease (RR 3.2, p = 0.0002), overall mortality (RR 2.3, p < 0.0001) and cardiovascular mortality (RR 2.6, p < 0.0001) than non-diabetic patients. Mortality was higher in diabetic patients following admission for clinically diagnosed ischaemic heart disease (RR 1.7, p = 0.05) and cardiac failure (RR 2.2, p = 0.0003). Among diabetic patients older age, left ventricular hypertrophy, smoking, clinically diagnosed ischaemic heart disease, cardiac failure and hypoalbuminaemia were independently associated with mortality. The excessive cardiac morbidity and mortality of diabetic patients seem to be mediated via ischaemic disease, rather than progression of cardiomyopathy while on dialysis therapy. Potentially remediable risk factors include smoking, left ventricular hypertrophy, and hypoalbuminaemia.
ISSN:0012-186X
1432-0428
DOI:10.1007/s001250050825