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Cardiovascular risk factors and cardiovascular death in haemodialysed diabetic patients
Insights
Diabetic patients on hemodialysis face significantly higher cardiovascular death rates compared to non-diabetics. Non-coronary heart muscle disease may explain many of these deaths in diabetic individuals.
Area of Science:
- Nephrology
- Cardiology
- Diabetology
Background:
- Uremia significantly increases cardiovascular risk.
- Diabetes mellitus further exacerbates cardiovascular complications in patients with kidney disease.
Purpose of the Study:
- To compare mortality causes and cardiovascular risk factors in diabetic versus non-diabetic patients undergoing hemodialysis.
- To investigate predictors of cardiovascular death in diabetic patients with end-stage renal disease.
Main Methods:
- Retrospective analysis of 200 diabetic and 200 matched non-diabetic patients on hemodialysis.
- Evaluation of causes of death and established cardiovascular risk factors.
Main Results:
- Diabetic patients exhibited substantially higher total and cardiovascular mortality (Type I: 4.8-fold, Type II: 3.0-fold).
- Cardiovascular causes accounted for 58% of deaths in diabetics vs. 38% in non-diabetics.
- Sudden death was the predominant cause, exceeding myocardial infarction and stroke, with hypertension and cardiomegaly predicting cardiovascular death in diabetics.
Conclusions:
- Hemodialysis patients with diabetes have a markedly increased risk of cardiovascular death.
- Non-coronary cardiomyopathic mechanisms likely play a significant role in cardiovascular mortality among dialyzed diabetic patients.
- Hypertension and cardiomegaly are key predictors of cardiovascular death in this population.
Abstract:
In a retrospective study, causes of death and the cardiovascular risk conferred by established risk factors were analysed in 200 diabetic and 200 matched non-diabetic uraemic patients admitted for haemodialysis. Total and cardiovascular mortality was considerably higher in diabetics, both type I (4.8-fold) and type II (3.0-fold). Fifty-eight per cent of deaths in diabetics, but only 38 per cent of deaths in non-diabetics were due to cardiovascular causes; myocardial infarction and stroke accounted for less than 15 per cent of deaths, the majority being due to sudden death. Cardiovascular death in diabetes was predicted by both history of hypertension and by cardiomegaly, but to a much lesser extent by clinical evidence of macroangiopathy. The results are compatible with an important role of non-coronary cardiomyopathic mechanisms of cardiovascular death in dialysed diabetics.