title: Diabetes mellitus, aortic stiffness, and cardiovascular mortality in end-stage renal disease.
abstract: Cardiovascular mortality is elevated in patients with end-stage renal disease (ESRD), especially in those with diabetes mellitus. Although the higher cardiovascular death rate in diabetic ESRD patients may be the result of more advanced atherosclerotic changes of the arterial wall, this has not been documented previously. Aortic stiffness was compared between ESRD patients with and without diabetes, and the impact of aortic stiffness on cardiovascular mortality was examined in a prospective, observational cohort study. The cohort consisted of 265 ESRD patients on hemodialysis, including 50 diabetic patients studied between June 1992 and December 1998. At baseline, the diabetic ESRD patients had significantly higher aortic pulse wave velocity (PWV), a noninvasive measure of aortic stiffness, than the nondiabetic patients. During a mean follow-up period of 63 mo, 81 deaths, including 36 cardiovascular deaths, were recorded. Kaplan-Meier analysis revealed higher all-cause or cardiovascular mortality rates in the diabetic as compared with the nondiabetic patients and also in those with higher aortic PWV than those with lower aortic PWV. The effect of diabetes on cardiovascular death was significant in the Cox model, including age, years on hemodialysis, gender, smoking, C-reactive protein, hematocrit, and body mass index as covariates. However, when aortic PWV was included as a covariate, the impact of diabetes was no longer significant, whereas aortic PWV was a significant predictor. In a model including 13 covariates, aortic PWV remained a significant predictor for cardiovascular and overall mortality but not for non-cardiovascular death. These results demonstrate that the increased aortic stiffness of the ESRD patients with diabetes mellitus contributed to the higher all-cause and cardiovascular mortality rates.
authors.affiliation: Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Shoji
authors.affiliation: Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Emoto
authors.affiliation: Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Kayo
authors.initials: K
authors.lastname: Shinohara
authors.affiliation: Division of Internal Medicine, Inoue Hospital, Suita, Japan.
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Kakiya
authors.affiliation: Division of Internal Medicine, Inoue Hospital, Suita, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Tsujimoto
authors.affiliation: Division of Internal Medicine, Inoue Hospital, Suita, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kishimoto
authors.affiliation: Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Ishimura
authors.affiliation: Division of Internal Medicine, Inoue Hospital, Suita, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Tabata
authors.affiliation: Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Nishizawa
mesh_terms: D001011:Aorta / Q000503:physiopathology; D001018:Aortic Diseases / Q000150:complications*; D001783:Blood Flow Velocity; D002318:Cardiovascular Diseases / Q000150:complications* / Q000378:metabolism*; D048909:Diabetes Complications; D004548:Elasticity; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011674:Pulse; D016019:Survival Analysis