Survival and predictors of death in dialysed diabetic patients

Koch, Michael; Thomas, Beverley; Tschöpe, W.; Ritz, Eberhard

doi:10.1007/bf02374508

Cited by 127 publications

(54 citation statements)

References 17 publications

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“…With respect to total mortality and CVE, we found a significant association in the univariate, but not in the multivariate, analyses. This is partly consistent with earlier findings but does not comply with data mainly derived from echocardiographic studies showing a clear association between LVH and mortality in hemodialysis populations (19)(20)(21)(22)(23). This might be due to the fact that the sensitivity of hypertrophy markers in the ECG is low (24,25).…”

Section: Discussionsupporting

confidence: 76%

Electrocardiography and Outcome in Patients with Diabetes Mellitus on Maintenance Hemodialysis

Krane

Heinrich²,

Meesmann³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: In hemodialysis, applicable guidelines recommend regular electrocardiogram (ECG) recordings.However, respective systematic evaluations are absent. Thus, the authors investigated whether routine ECG findings add prognostic information to standard risk assessment in hemodialysis.Design, setting, participants, & measurements: The relationship between nine common baseline ECG variables and a combined cardiovascular endpoint (CVE; cardiac death, myocardial infarction, stroke), sudden death, stroke, MI, and all-cause death in 1253 patients from the German Diabetes and Dialysis Study was evaluated. All patients were on maintenance hemodialysis, had type 2 diabetes mellitus, and received randomized treatment with atorvastatin or placebo.Results: During 4 yr of follow-up (March 1998 to March 2004), 469 patients reached the CVE, and 617 died. After adjustment for demographics, comorbidities, and biomarkers in multivariate analysis, patients presenting without sinus rhythm were 89% more likely to die, and the risk of CVE and stroke increased by 75% and 164%, respectively, compared with patients with preserved sinus rhythm. Left ventricular hypertrophy was associated with >2-fold increase in the risk of stroke and a 60% increase in the risk of sudden death.Conclusions: In hemodialysis patients with type 2 diabetes mellitus, the absence of sinus rhythm is a risk indicator for CVE, stroke, and all-cause death, and left ventricular hypertrophy is associated with stroke and sudden death. Thus, routine ECG recording adds prognostic information to standard risk assessment.

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Section: Discussionsupporting

confidence: 76%

Electrocardiography and Outcome in Patients with Diabetes Mellitus on Maintenance Hemodialysis

Krane

Heinrich²,

Meesmann³

et al. 2009

Clinical Journal of the American Society of Nephrology

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“…What observational data (a study of ours and apparently never fully published URREA data [85]) suggest is that the risk for cardiovascular death and overall death, respectively, is less in dialysis patients on ␤ blockers (58,59). There are, to the best of my knowledge, no specific data available on sudden death.…”

Section: Remaining Challengesmentioning

confidence: 75%

“…␤ Blockers. In one observational study on hemodialyzed type 2 diabetic patients, Koch et al (58) observed that 4% of the patients who died from cardiovascular causes but no less than 12% of those who survived had been on ␤ blockers, suggesting a benefit from ␤ blockers. Consequently, we had strongly argued for the more widespread use of ␤ blockers in dialyzed patients, particularly in diabetics (59).…”

Section: Primary Preventionmentioning

confidence: 99%

The Challenge of Sudden Death in Dialysis Patients

Ritz¹,

Wanner²

2008

Clinical Journal of the American Society of Nephrology

114

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A 60-yr-old patient with ESRD (82 kg/168 cm), hypertension for the previous 18 yr, and type 2 diabetes is found dead in bed by his wife at home on a Saturday morning. The patient's history is notable for having started dialysis 34 weeks previously. His last dialysis had been the previous day (on a Friday afternoon). Predialysis potassium had been 5.7 mmol/L, the dialysate K ϩ was 2.0 mmol/L, and Mg 2ϩ was 0.5 mmol/L. Autopsy was not performed.Before his morbid event, the patient had been doing well on dialysis. He had less than 6 episodes of hypotension (Ͻ100 mmHg) per month. His average predialytic weight gain was 4 kg, and, with fluctuations, his average predialysis BP was 155/65 mmHg. While continuing on gliquidone (an oral sulfonylurea hypoglycemic drug that does not accumulate in renal failure), he had no episodes of hypoglycemia, and his last glycosylated hemoglobin level was 7.2%. His medical history is of hypertension, type 2 diabetes, and left ventricular hypertrophy (LVH) with an ejection fraction of 55%. His electrocardiogram showed signs of LVH and flat T waves. He had no history of hypoglycemic episodes and no evidence of retinopathy. He reported no episodes of arrhythmia or precordial pain. A predialysis chest x-ray 2 wk before the terminal event had shown pulmonary congestion. His medications included 0.25 g/d calcitriol, calcium carbonate, 10 mg of folate, 80 mg of verapamil, and no ␤ blockers. In addition, he received varying doses of darbepoietin and iron gluconate as required. He did not receive a statin. Dr. Eberhard Ritz: This case, unfortunately, is the usual presentation of patients on dialysis who succumb to sudden death: There are few, if any, specific premonitory symptoms or signs, cardiac standstill is usually the presenting symptom, and autopsy is not performed, so more specific information on underlying cardiac pathology, if any, is not available. The lack of pathoanatomic confirmation of the underlying pathology or pathologies-as in this case-continues to remain a problem that in the future should come onto the radar screen of nephrologists.Nevertheless, this case presentation raises a number of unresolved issues and provides an occasion to discuss how the currently unsatisfactory results might be improved in the future. In this context, it is of interest to have a look at the recent 4D study.

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“…In previous studies, older age, malnutrition (14,16), dyslipidemia (17,18), and coexistence of cardiovascular disease (11,12,14,15) were reported to affect the survival rate of diabetic ESRD patients after the initiation of hemodialysis. The most common cause of death of diabetic patients with ESRD as well as of diabetic patients without ESRD is cardiovascular disease.…”

Section: Causes Of Deathmentioning

confidence: 98%

“…Several studies identified clinical predictors of survival of diabetic end-stage renal disease (ESRD) patients on hemodialysis, including age at hemodialysis initiation (11)(12)(13)(14)(15), nutritional status (14,16), dyslipidemia (17,18), and existence of cardiovascular complications (11,12,14,15). However, it is still unknown whether glycemic control has beneficial effects in diabetic patients with advanced nephropathy.…”

mentioning

confidence: 99%

Glycemic Control Is a Predictor of Survival for Diabetic Patients on Hemodialysis

et al. 2001

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OBJECTIVE -To investigate the impact of glycemic control on the survival of diabetic subjects with end-stage renal disease (ESRD) starting hemodialysis treatment. RESEARCH DESIGN AND METHODS-This single-center prospective observational study enrolled 150 diabetic ESRD subjects (109 men and 41 women; age at hemodialysis initiation, 60.5 Ϯ 10.2 years) at start of hemodialysis between January 1989 and December 1997. The subjects were divided into groups according to their glycemic control level at inclusion as follows: good HbA 1c Ͻ7.5%, n ϭ 93 (group G), and poor HbA 1c Ն7.5%, n ϭ 57 (group P); and survival was followed until December 1999, with a mean follow-up period of 2.7 years.RESULTS -Group G had better survival than group P (the control group) (P ϭ 0.008). At inclusion, there was no significant difference in age, sex, systolic blood pressure (SBP), BMI, cardio-to-thoracic ratio (CTR) on chest X-ray, and serum creatinine (Cre) or hemoglobin (Hb) levels between the two groups. After adjustment for age and sex, HbA 1c was a significant predictor of survival (hazard ratio 1.133 per 1.0% increment of HbA 1c , 95% CI 1.028 -1.249, P ϭ 0.012), as were Cre and CTR.CONCLUSIONS -Good glycemic control (HbA 1c Ͻ7.5%) predicts better survival of diabetic ESRD patients starting hemodialysis treatment. Diabetes Care 24:909 -913, 2001

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Survival and predictors of death in dialysed diabetic patients

Cited by 127 publications

References 17 publications

Electrocardiography and Outcome in Patients with Diabetes Mellitus on Maintenance Hemodialysis

Electrocardiography and Outcome in Patients with Diabetes Mellitus on Maintenance Hemodialysis

The Challenge of Sudden Death in Dialysis Patients

Glycemic Control Is a Predictor of Survival for Diabetic Patients on Hemodialysis

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