title: Impact of diabetes on cardiovascular outcomes in hemodialysis patients undergoing coronary revascularization.
abstract: BACKGROUND
  Among hemodialysis (HD) patients, those who have diabetes have poorer cardiovascular outcomes than non-diabetic patients, but the impact of diabetes on cardiovascular outcomes has not been fully elucidated in HD patients undergoing coronary revascularization.
  
  
  RESULTS
  We identified 375 HD patients (203 diabetes, 172 non-diabetes) and 9,006 patients without HD (3,455 diabetes, 5,551 non-diabetes) in the database of the CREDO-Kyoto registry of patients undergoing their first coronary revascularization. In non-HD patients, significantly higher risks of death (10.8% vs. 7.7%, P < 0.0001; adjusted hazard ratio (HR) 1.29, P < 0.0001) and major adverse cardiovascular events (MACE), a composite of death, myocardial infarction and stroke (18.8% vs. 13.3%, P < 0.0001; HR 1.36, P < 0.0001) were seen in diabetic patients than in non-diabetic patients through 4-year follow-up. Analysis in HD patients showed that the duration of HD before first coronary revascularization was significantly shorter in diabetic patients than in non-diabetic patients (median interval: 858 vs. 2,216 days, P < 0.0001). In contrast to the results in non-HD patients, the risks of death (41.9% vs. 39.1%, P=0.75; HR 0.98, P=0.93) and MACE (45.6% vs. 45.8%, P=0.83; HR 0.87, P=0.50) after first revascularization were comparable between diabetic and non-diabetic HD patients. There were significant interactions between HD and diabetes for death and for MACE.
  
  
  CONCLUSIONS
  HD patients who require coronary revascularization have extremely poor outcomes irrespective of concomitant diabetes.
authors.affiliation: Department of Cardiovascular of Medicine, Graduate School of Medicine, Kyoto University, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Natsuaki
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Furukawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nakagawa
authors.forename: Masaharu
authors.initials: M
authors.lastname: Akao
authors.forename: Koh
authors.initials: K
authors.lastname: Ono
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Shioi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shizuta
authors.forename: Ryuzo
authors.initials: R
authors.lastname: Sakata
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Okabayashi
authors.forename: Noboru
authors.initials: N
authors.lastname: Nishiwaki
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Komiya
authors.forename: Satoru
authors.initials: S
authors.lastname: Suwa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015331:Cohort Studies; D015897:Comorbidity; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D048909:Diabetes Complications / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D007674:Kidney Diseases / Q000453:epidemiology / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control; D011379:Prognosis; D012042:Registries; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control; D015996:Survival Rate; D016896:Treatment Outcome