title: Low plasma α-tocopherol concentrations and adverse clinical outcomes in diabetic hemodialysis patients.
abstract: OBJECTIVE
  Trials with the antioxidant vitamin E have failed to show benefit in the general population. Considering the different causes of death in ESRD, this study investigated the association between plasma concentrations of α-tocopherol and specific clinical outcomes in diabetic hemodialysis patients.
  
  
  METHODS
  In 1046 diabetic hemodialysis patients (participants of the German Diabetes and Dialysis Study), α-tocopherol was measured in plasma by reversed-phase HPLC. By Cox regression analyses, hazard ratios were determined for prespecified end points according to baseline plasma α-tocopherol levels: sudden death (n=134), myocardial infarction (n=172), stroke (n=89), combined cardiovascular events (n=398), fatal infection (n=107), and all-cause mortality (n=508).
  
  
  RESULTS
  Patients had a mean age of 66±8 years, and mean plasma α-tocopherol level was 22.8±9.6 µmol/L. Levels of α-tocopherol were highly correlated to triglycerides (r=0.63, P<0.001). Patients in the lowest α-tocopherol quartile had (in unadjusted analyses) a 79% higher risk of stroke and a 31% higher risk of all-cause mortality compared with patients in the highest quartile. The associations were attenuated after adjustment for confounders (hazard ratiostroke=1.56, 95% confidence interval=0.75-3.25; hazard ratiomortality=1.22, 95% confidence interval=0.89-1.69, respectively). There was no association between α-tocopherol and myocardial infarction, sudden death, or infectious death.
  
  
  CONCLUSIONS
  Plasma α-tocopherol concentrations were not independently associated with cardiovascular outcomes, infectious deaths, or all-cause mortality in diabetic hemodialysis patients. The lack of association can partly be explained by a confounding influence of malnutrition, which should be considered in the planning of trials to reduce cardiovascular risk in dialysis patients.
authors: Department of Physiology and Pathophysiology of Nutrition, Institute of Nutritional Science, University of Potsdam, Potsdam, Germany.
authors: Katharina M
authors: KM
authors: Espe
authors: Jens
authors: J
authors: Raila
authors: Andrea
authors: A
authors: Henze
authors: Katja
authors: K
authors: Blouin
authors: Andreas
authors: A
authors: Schneider
authors: Daniel
authors: D
authors: Schmiedeke
authors: Vera
authors: V
authors: Krane
authors: Stefan
authors: S
authors: Pilz
authors: Florian J
authors: FJ
authors: Schweigert
authors: Berthold
authors: B
authors: Hocher
authors: Christoph
authors: C
authors: Wanner
authors: Christiane
authors: C
authors: Drechsler
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D002851:Chromatography, High Pressure Liquid; D056148:Chromatography, Reverse-Phase; D003141:Communicable Diseases / Q000401:mortality; D015986:Confounding Factors, Epidemiologic; D003928:Diabetic Nephropathies / Q000097:blood* / Q000401:mortality / Q000628:therapy*; D015536:Down-Regulation; D005260:Female; D005858:Germany; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D044342:Malnutrition / Q000401:mortality; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D024502:alpha-Tocopherol / Q000097:blood*
chemical_list: D015415:Biomarkers; D024502:alpha-Tocopherol