title: Different impact of biomarkers as mortality predictors among diabetic and nondiabetic patients undergoing hemodialysis.
abstract: Diabetic patients undergoing hemodialysis demonstrate much worse survival rates than do nondiabetic patients undergoing hemodialysis. To search for risk predictors, a prospective cohort study was performed with 245 hemodialysis patients, including 84 with diabetes mellitus, for 2 yr. C-reactive protein, troponin T (TnT), total, HDL, LDL, and lipoprotein(a) cholesterol, apoA2, apoB, triglyceride, fibrinogen, D-dimer, albumin, and creatinine levels and clinical characteristics at the time of entry were recorded. Survival rates were compared with Kaplan-Meier and Cox regression analyses. Forty-three diabetic patients and 30 nondiabetic patients died. Among diabetic patients, oliguria (<200 ml/d) (relative risk, 3.24; 95% confidence interval, 1.63 to 6.41; P = 0.001), elevated C-reactive protein levels (relative risk, 2.57; 95% confidence interval, 1.06 to 6.18; P = 0.035), and elevated D-dimer levels (relative risk, 2.36; 95% confidence interval, 1.11 to 5.01; P = 0.025) predicted all-cause mortality rates. Oliguria was by far the most important predictor, particularly for infectious disease-related death (relative risk, 23.35; 95% confidence interval, 2.60 to 209.97; P = 0.005). Among nondiabetic patients, elevated TnT levels (relative risk, 4.00; 95% confidence interval, 1.58 to 10.10; P = 0.003), elevated D-dimer levels (relative risk, 3.45; 95% confidence interval, 1.27 to 9.33; P = 0.015), and low cholesterol levels (relative risk, 3.61; 95% confidence interval, 1.34 to 9.71; P = 0.011) predicted all-cause mortality rates. Subdivision of the causes of death among nondiabetic patients revealed that TnT levels predicted cardiovascular mortality rates (relative risk, 5.38; 95% confidence interval, 1.11 to 26.10; P = 0.037) and infectious disease-related mortality rates (relative risk, 12.02; 95% confidence interval, 1.42 to 191.96; P = 0.023). In conclusion, mortality predictors among patients undergoing hemodialysis differed substantially between diabetic and nondiabetic patients. Strategies to reduce mortality rates should consider these differences.
authors.affiliation: Department of Nephrology and Institute of Laboratory Medicine, University Hospital Charité, Humboldt University of Berlin, Berlin, Germany. berthold.hocher@charite.de
authors.forename: Berthold
authors.initials: B
authors.lastname: Hocher
authors.forename: Reinhard
authors.initials: R
authors.lastname: Ziebig
authors.forename: Claudia
authors.initials: C
authors.lastname: Altermann
authors.forename: Rolfdieter
authors.initials: R
authors.lastname: Krause
authors.forename: Gernot
authors.initials: G
authors.lastname: Asmus
authors.forename: Claus-Michael
authors.initials: CM
authors.lastname: Richter
authors.forename: Torsten
authors.initials: T
authors.lastname: Slowinski
authors.forename: Pranav
authors.initials: P
authors.lastname: Sinha
authors.forename: Hans-H
authors.initials: HH
authors.lastname: Neumayer
mesh_terms: D001053:Apolipoproteins / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D001798:Blood Proteins / Q000378:metabolism; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000097:blood* / Q000401:mortality*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D011237:Predictive Value of Tests; D011446:Prospective Studies; D006435:Renal Dialysis; D012307:Risk Factors; D015996:Survival Rate; D014280:Triglycerides / Q000097:blood; D020107:Troponin T / Q000097:blood
chemical_list: D001053:Apolipoproteins; D015415:Biomarkers; D001798:Blood Proteins; D014280:Triglycerides; D020107:Troponin T; D002784:Cholesterol; D003404:Creatinine