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Higher Heart Risk Seen with Diabetes Plus ESRD

Diabetes and end stage renal disease (ESRD), when together, contribute to increased cardiovascular (CV) events, such as acute myocardial infarction and stroke….

Data from the study came from two representative national cohorts, which was used to determine "age- and sex-specific incidences, [and] twenty-year risks of incident CV events… stratified by the presence of diabetes, de novo diabetes after ESRD or ESRD." The types of cardiovascular events that were analyzed included acute myocardial infarction (AMI), stroke, and congestive heart failure (CHF).

Individuals were excluded from the study if they were younger than 18 years of age and/or if they had previously experienced a CV event before the study started. The study was conducted using Cox proportional hazard models, which adjusted for the varied risk of mortality among the participants.

There were a total of 648,851 non-ESRD patients with 53,342 having diabetes, and 71,397 ESRD patients with 34,754 having diabetes. These patients were monitored from the years 1998 to 2009.

After separating patients by age and sex, it was seen that the occurrence of a CV event had a very positive and one directional risk pattern when associated with the presence of diabetes, ESRD, or both diabetes and ESRD. De novo diabetes also showed a similar pattern, with increased risks for CV events, especially for AMI and stroke. In patients with diabetes and ESRD there was a "multiplicatively synergistic effect" seen in regards to increasing the risk for AMI and stroke specifically; the adjusted hazard ratios were 5.24 [4.83-5.68] and 2.43[2.32-2.55], respectively when compared to individuals without diabetes or ESRD. De novo diabetes after ESRD also displayed a similar pattern.

The authors conclude that when patients have diabetes and ESRD, they are at a higher risk for a cardiovascular event due to their synergistic effect. In order to avoid such an event, they recommend that screening of diabetes be done regularly in patients that have ESRD. If these ESRD patients are also presented with diabetes, then there blood glucose should be constantly monitored and controlled.

Sung JM, et al "Diabetes and end-stage renal disease synergistically contribute to increased incidence of cardiovascular events: A nationwide follow-up study during 1998-2009" Diabetes Care 2013; DOI: 10.2337/dc13-078.