title: Type II diabetes mellitus is a risk factor for heart failure in pre-dialysis patients.
abstract: Chronic kidney disease (CKD) increases the risk of developing cardiovascular diseases such as heart failure (HF) and ischemic heart disease (IHD). The characteristics of patients with CKD complicated with HF at the time of starting hemodialysis have not yet been evaluated. We enrolled 347 patients in this study and compared gender, age, body mass index, laboratory data, causative disease, complications, and echocardiographic findings between groups with (n = 105) and without (n = 242) HF. Type II diabetic nephropathy and estimated glomerular filtration rate (eGFR; mL/min/1.73 m(2) ) were the independent factors for HF (OR: 3.004, 95% CI: 1.754 to 5.146 and OR: 1.215, 95% CI: 1.101 to 1.330, [per 1 mL/min/1.73 m(2) increase], respectively). The higher GFR appeared to be not a risk factor for HF, probably because the HF group included patients who required periodic dialysis to prevent fatal HF, even if their renal function was not extremely deteriorated. The prevalence of hypertension, IHD and values of body mass index, triglycerides, and LDL-cholesterol did not differ between these two groups. Echocardiographic data showed that left ventricular mass index was an independent risk factor for HF (OR: 1.006, 95% CI: 1.001 to 1.012, per 1 g/m(2) increase) and more than half of the patients appeared to have left ventricular diastolic dysfunction. Our findings suggest that not only CKD, but also type II DM, is a potent risk for left ventricular dysfunction, which causes HF and IHD in pre-dialysis patients with CKD.
authors.affiliation: Division of Nephrology, Shuuwa General Hospital, Kasukabe, Saitama, Japan. kuwaharam@shuuwa-gh.or.jp
authors.forename: Michio
authors.initials: M
authors.lastname: Kuwahara
authors.forename: Junichi
authors.initials: J
authors.lastname: Ishigami
authors.forename: Satomi
authors.initials: S
authors.lastname: Shikuma
authors.forename: Wataru
authors.initials: W
authors.lastname: Akita
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Mori
authors.forename: Tomoki
authors.initials: T
authors.lastname: Asai
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Tsukamoto
authors.forename: Susumu
authors.initials: S
authors.lastname: Adachi
authors.forename: Yumi
authors.initials: Y
authors.lastname: Noda
authors.forename: Tatemitsu
authors.initials: T
authors.lastname: Rai
authors.forename: Shinichi
authors.initials: S
authors.lastname: Uchida
authors.forename: Sei
authors.initials: S
authors.lastname: Sasaki
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004452:Echocardiography; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology*; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000453:epidemiology / Q000209:etiology