title: Effect of vascular comorbidities on survival of type 2 diabetes patients on renal replacement therapy.
abstract: BACKGROUND
  Atherosclerosis is an important predictor of mortality in patients with end-stage renal disease. The aim of this study was to determine how various vascular comorbidities such as coronary heart disease (CHD), peripheral vascular disease (PVD) or cerebrovascular disease (CeVD) affect survival of type 2 diabetic patients on renal replacement therapy (RRT).
  
  
  METHODS
  Patients who entered RRT because of type 2 diabetes in 2000-2008 (n = 877) were identified within the Finnish Registry for Kidney Diseases. The patients were followed up until death or end of follow-up. Survival probabilities were calculated using Kaplan-Meier curves. Multivariate modeling was performed using Cox regression.
  
  
  RESULTS
  41% of the patients had CHD, 27% PVD and 16% CeVD at the start of RRT. Patients with PVD had a 1.9-fold (95% CI 1.6-2.3) risk of death compared to those without PVD when adjusting for age and gender, while patients with CHD had a 1.5-fold (95% CI 1.2-1.8) and those with CeVD a 1.4-fold (95% CI 1.1-1.8) risk compared to those without these diseases. The hazard ratio (HR) for death was highest in patients with the combination of PVD and either CHD (HR 2.8, 95% CI 2.1-3.8) or CeVD (HR 2.9, 95% CI 1.6-5.2) as compared to patients without any vascular comorbidities.
  
  
  CONCLUSIONS
  PVD is the vascular comorbidity that increases risk of death the most among patients with type 2 diabetes starting RRT. Prevention of PVD in this patient group would merit further studies.
authors.affiliation: Department of Internal Medicine, Kuopio University Hospital, Kuopio, Finland. marjo.kervinen@kuh.fi
authors.forename: Marjo
authors.initials: M
authors.lastname: Kervinen
authors.forename: Seppo
authors.initials: S
authors.lastname: Lehto
authors.forename: Carola
authors.initials: C
authors.lastname: Grönhagen-Riska
authors.forename: Patrik
authors.initials: P
authors.lastname: Finne
mesh_terms: D000368:Aged; D002561:Cerebrovascular Disorders / Q000401:mortality*; D015897:Comorbidity; D016001:Confidence Intervals; D003327:Coronary Disease / Q000401:mortality*; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000401:mortality*; D016016:Proportional Hazards Models; D017582:Renal Replacement Therapy