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Updated: Nov 18, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Diabetes, Cardiovascular Disease, and Cardiovascular Risk in Patients with Chronic Kidney Disease
Jose J G De Lima1, Luis Henrique W Gowdak2, Elias David-Neto3
1Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Rua Enas Carvalho Aguiar 44, São Paulo, SP, 05403-000, Brazil. jose.lima@incor.usp.br.
Insights
In hemodialysis patients, diabetes and cardiovascular disease (CVD) pose similar risks for cardiovascular events. This suggests diabetes is equivalent to CVD in this high-risk population.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- The elevated cardiovascular disease (CVD) risk in diabetic patients undergoing dialysis is not fully understood.
- It remains unclear if diabetes itself or its associated CVD contributes more significantly to this risk.
Purpose of the Study:
- To determine if diabetes and pre-existing CVD have comparable impacts on cardiovascular event incidence in patients on maintenance hemodialysis.
- Investigating the equivalence of risk between diabetes and CVD in hemodialysis patients.
Main Methods:
- A prospective study evaluated 310 diabetic patients on hemodialysis without clinical CVD and 395 non-diabetic patients with CVD.
- Follow-up assessed the incidence of composite cardiovascular and coronary events.
- Sensitivity analyses excluded patients with potential occult CVD to confirm findings.
Main Results:
- No significant difference in the incidence of composite cardiovascular events or coronary events was observed between diabetic and CVD groups.
- Excluding patients with potential occult CVD in the diabetic group did not alter the results.
- Both diabetes and CVD presented similar risks for adverse cardiovascular outcomes.
Conclusions:
- Diabetes and cardiovascular disease confer similar risks for cardiovascular events in patients undergoing hemodialysis.
- These findings support the concept of diabetes mellitus-CVD risk equivalence in the general population, extended to hemodialysis patients.
Introduction:
It is unclear whether the increased risk associated with diabetes in patients on dialysis is due to diabetes or a consequence of associated cardiovascular disease (CVD).
Aim:
The purpose of this work was to answer the question: do diabetes and CVD have a similar impact on the incidence of cardiovascular events in patients undergoing maintenance hemodialysis?
Methods:
A prespecified protocol was used to prospectively evaluate and follow up 310 diabetic patients on hemodialysis without clinical evidence of CVD and 395 nondiabetic patients with CVD. Endpoint was the incidence of composite CV events and coronary events.
Results:
The incidence of composite CV events (log-rank = 0.540) and coronary events (log-rank = 0.400) did not differ between groups. Because of the potential influence of occult CVD in patients with diabetes, we repeated the analysis excluding subjects with altered ejection fraction, a myocardial perfusion scan defect, and coronary artery disease in the group of patients with diabetes. Again we found no difference between groups (log-rank = 0.657).
Conclusion:
In patients on hemodialysis, diabetes and CVD carry similar risks for CV events. These results are congruent with the diabetes mellitus-CVD equivalence risk concept reported in the general population.
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