Effects of gender, Helicobacter pylori and hepatitis B virus serology status on cardiovascular and renal complications in Chinese type 2 diabetic patients with overt nephropathy.
BACKGROUND
The aim of this study was to investigate whether chronic infections with Helicobacter pylori and hepatitis B virus (HBV) might affect clinical outcomes in Chinese type 2 diabetic patients with advanced nephropathy.


METHODS
A prospective study of 97 type 2 diabetic patients with clinical proteinuria and renal insufficiency (median serum creatinine 200 micro mol/l).


RESULTS
During a median follow-up period of 2 years, 34 developed end-stage renal disease (ESRD), 28 had cardiovascular endpoints and 11 patients had died (seven men and four women), and 52.7% developed a combined endpoint. Female patients had longer disease duration, higher blood pressure, lower body weight but higher serum creatinine and spot urine albumin : creatinine ratio as well as lower haemoglobin than male patients. On logistic regression analysis, female gender (hazard ratio: 5.91, p = 0.02), negative H. pylori serology (8.39, p = 0.004), baseline serum creatinine (1.04, p = 0.001) and haemoglobin (1.86, p = 0.01) were independent predictors for ESRD. Systolic blood pressure (1.04, p = 0.003), prior treatment with angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists (3.41, p = 0.04) and positive hepatitis B surface antigen (4.88, p = 0.025) were independent predictors for cardiovascular endpoints. Female gender (7.89, p = 0.002) and baseline serum creatinine (1.05, p < 0.001) were independent predictors for combined death and cardio-renal endpoints.


CONCLUSIONS
In Chinese type 2 diabetic patients with clinical proteinuria renal insufficiency, there were high rates of death and cardio-renal outcomes. Female gender, low haemoglobin and negative H. pylori serology were important predictors for ESRD, whereas chronic HBV infection was associated with increased cardiovascular risks.
Lo
M K W
MK
Medical Unit, Pamela Youde Eastern Hospital, Hong Kong.
Lee
K-F
KF
Chan
N N
NN
Leung
W Y S
WY
Ko
G T C
GT
Chan
W-B
WB
So
W-Y
WY
Ng
M C Y
MC
Ho
C-S
CS
Tam
J S L
JS
Lam
C W K
CW
Tong
P C Y
PC
Chan
J C N
JC
D000418:Albumins / Q000032:analysis; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000209:etiology; D003404:Creatinine / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000378:metabolism; D003925:Diabetic Angiopathies / Q000150:complications* / Q000378:metabolism; D003928:Diabetic Nephropathies / Q000150:complications* / Q000378:metabolism; D005260:Female; D016481:Helicobacter Infections / Q000150:complications*; D016480:Helicobacter pylori; D006454:Hemoglobins / Q000032:analysis; D006509:Hepatitis B / Q000150:complications*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012737:Sex Factors
D000418:Albumins; D000806:Angiotensin-Converting Enzyme Inhibitors; D006454:Hemoglobins; D003404:Creatinine