title: Do biologic markers predict cardiovascular end points in diabetic end-stage renal disease? A prospective longitudinal study.
abstract: BACKGROUND
  Diabetic patients on hemodialysis are at high risk of death from cardiovascular disease, and research has suggested that various biologic markers of inflammation, oxidative stress and hemostasis may give added value to clinical information for predicting cardiovascular event (CVE)-free survival. This information could be particularly important in evaluating this population for renal transplant, given the scarcity of organs. We hypothesized that in diabetic patients undergoing renal replacement therapy (RRT) these biologic markers would prove useful in predicting event-free follow-up in a prospective study.
  
  
  METHODS
  One hundred and fifty diabetic (76 type 1, 74 type 2) and 27 non-diabetic stable RRT patients were followed for 0.04-13.69 years for CVE (myocardial infarction, coronary arterial intervention, peripheral arterial bypass or amputation, cerebrovascular accident or carotid artery intervention), cardiac and all-cause mortality. Measured biologic markers of inflammation included the following: Il-6, C reactive protein, fibrinogen; of hemostasis: fibrinogen, plasminogen activator inhibitor (PAI), fibrinolytic activity, von Willebrand factor VII (vWF), platelet-selectin, viscosity and of oxidative stress: advanced glycated end products and antibody to oxidized low-density lipoprotein. For each, upper versus lower tertiles were compared for duration of event-free follow-up.
  
  
  RESULTS
  Cardiovascular events prior to study entry occurred in 51.3% of DM1, 54.0% of DM2 and 25.9% of DM0 patients. Subsequent cardiovascular events were noted in 31.6% of DM1, 45.9% of DM2 and 11.1% of DM0 patients. All mean levels of biologic markers at baseline were abnormal (P < 0.05).
  
  
  CONCLUSIONS
  In this RRT population, all biologic marker levels except PAI did not improve clinical prediction of events.
authors.affiliation: Division of Kidney Diseases and Hypertension , Rhode Island Hospital , Providence , RI , USA ; Department of Medicine, Alpert School of Medicine , Brown University , Providence , RI , USA.
authors.forename: George P
authors.initials: GP
authors.lastname: Bayliss
authors.affiliation: Joslin Diabetes Center , Beth Israel Deaconess Medical Center , Boston, MA , USA ; Department of Medicine, Harvard Medical School, Boston, MA , USA.
authors.forename: Larry A
authors.initials: LA
authors.lastname: Weinrauch
authors.affiliation: Department of Medicine, Harvard Medical School, Boston, MA , USA.
authors.forename: Ray E
authors.initials: RE
authors.lastname: Gleason
authors.affiliation: Laboratory for Biology and Human Genetics , North Shore University Hospital , Manhassett, NY , USA.
authors.forename: Annette T
authors.initials: AT
authors.lastname: Lee
authors.affiliation: Joslin Diabetes Center , Beth Israel Deaconess Medical Center , Boston, MA , USA ; Department of Medicine, Harvard Medical School, Boston, MA , USA.
authors.forename: John A
authors.initials: JA
authors.lastname: D'Elia
keywords: biologic markers; cardiovascular events; diabetes; plasminogen activator inhibitor; renal replacement therapy