Coronary revascularization improves long-term prognosis in diabetic and nondiabetic end-stage renal disease.
To test the hypothesis that coronary revascularization improves long-term prognosis in patients with hemodialysis, 80 of 121 patients (66%) on maintenance hemodialysis who had undergone initial coronary angiography had bypass surgery, catheter angioplasty, or both between 1983 and 1999. Multivessel disease was more frequent (p=0.01) and the duration of hemodialysis therapy was shorter (p=0.01) in patients with diabetes (n=61), than in nondiabetic patients (n=60). Of the patients who underwent revascularization, complete revascularization was achieved in 75% of those with diabetic nephropathy (30/40) and 83% in a similar number of nondiabetic patients (33/40). The 5-year survival rate from initiation of hemodialysis was 79% in diabetic and 96% in non-diabetic patients (p<0.01), exceeding published Japanese (53% vs 70%) and US (26% vs 60%) survival rates. When survival was studied from the date of revascularization, predictors of outcome were age and achievement of complete revascularization. Surprisingly, diabetes was not a predictor of survival outcome. Complete revascularization improves long-term survival in both diabetic and nondiabetic patients.
Aoki
Jiro
J
Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
Ikari
Yuji
Y
Nakajima
Hiroyoshi
H
Sugimoto
Tokuichiro
T
Hara
Kazuhiro
K
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003928:Diabetic Nephropathies / Q000150:complications / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000401:mortality; D011379:Prognosis; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome