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 da ta were collected yearly. At baseline, diabetic patients (n = 116) had more echocardiographic concentric left ventricular hypertrophy (50 vs 38%, p = 0.03), clinically diagnosed ischaemic heart disease (32 vs 1 8%, p = 0.003) and cardiac failure (48 vs 24%, p < 0.00001) than nondi abetic patients (n = 317). After adjusting for age and sex, diabetic p atients had similar rates of progression of echocardiographic disorder s, and de novo cardiac failure, but higher rates of de novo clinically diagnosed ischaemic heart disease (RR 3.2, p = 0.0002), overall morta lity (RR 2.3, p < 0.0001) and cardiovascular mortality (RR 2.6, p < 0. 0001) than non-diabetic patients. Mortality was higher in diabetic pat ients following admission for clinically diagnosed ischaemic heart dis ease (RR 1.7, p = 0.05) and cardiac failure (RR 2.2, p = 0.0003). Amon g diabetic patients older age, left ventricular hypertrophy, smoking, clinically diagnosed ischaemic heart disease, cardiac failure and hypo albuminaemia were independently associated with mortality. The excessi ve cardiac morbidity and mortality of diabetic patients seem to be med iated via ischaemic disease, rather than progression of cardiomyopathy while on dialysis therapy. Potentially remediable risk factors includ e smoking, left ventricular hypertrophy, and hypoalbuminaemia.