Impact of Diabetes on Cardiovascular Outcomes in Hemodialysis Patients Undergoing Coronary Revascularization

• Natsuaki Masahiro

  Department of Cardiovascular of Medicine, Graduate School of Medicine, Kyoto University

• Furukawa Yutaka

  Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital

• Morimoto Takeshi

  Center for Medical Education, Graduate School of Medicine, Kyoto University

• Nakagawa Yoshihisa

  Division of Cardiology, Tenri Hospital

• Akao Masaharu

  Division of Cardiology, Kyoto Medical Center

• Ono Koh

  Department of Cardiovascular of Medicine, Graduate School of Medicine, Kyoto University

• Shioi Tetsuo

  Department of Cardiovascular of Medicine, Graduate School of Medicine, Kyoto University

• Shizuta Satoshi

  Department of Cardiovascular of Medicine, Graduate School of Medicine, Kyoto University

• Sakata Ryuzo

  Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University

• Okabayashi Hitoshi

  Department of Cardiovascular Surgery, Iwate Medical University

• Nishiwaki Noboru

  Department of Cardiovascular Surgery, Nara Hospital Kinki University Faculty of Medicine

• Komiya Tatsuhiko

  Department of Cardiovascular Surgery, Kurashiki Central Hospital

• Suwa Satoru

  Division of Cardiology, Juntendo University Shizuoka Hospital

• Kimura Takeshi

  Department of Cardiovascular of Medicine, Graduate School of Medicine, Kyoto University

抄録

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. (Circ J 2011; 75: 1616-1625)<br>

収録刊行物

• Circulation Journal

  Circulation Journal 75 (7), 1616-1625, 2011

  一般社団法人 日本循環器学会

キーワード

• Coronary artery disease
• Diabetes mellitus
• Hemodialysis
• Revascularization

詳細情報

• CRID: 1390001205103779968
• NII論文ID: 10029126458
• NII書誌ID: AA11591968
• DOI: 10.1253/circj.cj-10-1235
• COI: 1:STN:280:DC%2BC3MnivFKhug%3D%3D
• ISSN: 13474820
• ISSN: 13469843
• PubMed: 21532182
• Web Site: http://www.jstage.jst.go.jp/article/circj/75/7/75_CJ-10-1235/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2012001389
• 本文言語コード: en
• データソース種別:
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  • Crossref
  • PubMed
  • CiNii Articles
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