Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Rua Enas Carvalho Aguiar 44, São Paulo, SP, 05403-000, Brazil.
Renal Transplant Unit, Urology, Hospital das Clínicas, University of São Paulo Medical School, Rua Eneas Carvalho Aguiar 23, São Paulo, SP, 05403-000, Brazil.
High Blood Press Cardiovasc Prev. 2021 Mar;28(2):159-165. doi: 10.1007/s40292-021-00434-0. Epub 2021 Feb 6.
It is unclear whether the increased risk associated with diabetes in patients on dialysis is due to diabetes or a consequence of associated cardiovascular disease (CVD).
The purpose of this work was to answer the question: do diabetes and CVD have a similar impact on the incidence of cardiovascular events in patients undergoing maintenance hemodialysis?
A prespecified protocol was used to prospectively evaluate and follow up 310 diabetic patients on hemodialysis without clinical evidence of CVD and 395 nondiabetic patients with CVD. Endpoint was the incidence of composite CV events and coronary events.
The incidence of composite CV events (log-rank = 0.540) and coronary events (log-rank = 0.400) did not differ between groups. Because of the potential influence of occult CVD in patients with diabetes, we repeated the analysis excluding subjects with altered ejection fraction, a myocardial perfusion scan defect, and coronary artery disease in the group of patients with diabetes. Again we found no difference between groups (log-rank = 0.657).
In patients on hemodialysis, diabetes and CVD carry similar risks for CV events. These results are congruent with the diabetes mellitus-CVD equivalence risk concept reported in the general population.
在接受透析治疗的患者中，糖尿病相关风险的增加是源于糖尿病还是源于相关心血管疾病（CVD）尚不清楚。
本研究旨在回答以下问题：在接受维持性血液透析的患者中，糖尿病和 CVD 是否对心血管事件的发生有相似的影响？
采用预设方案前瞻性评估和随访 310 例无 CVD 临床证据的糖尿病透析患者和 395 例有 CVD 的非糖尿病患者。终点为复合 CV 事件和冠状动脉事件的发生率。
复合 CV 事件（log-rank=0.540）和冠状动脉事件（log-rank=0.400）的发生率在两组间无差异。由于糖尿病患者中隐匿性 CVD 的潜在影响，我们在糖尿病组中排除了射血分数改变、心肌灌注扫描缺损和冠状动脉疾病的患者，再次分析两组间无差异（log-rank=0.657）。
在血液透析患者中，糖尿病和 CVD 对 CV 事件的风险相似。这些结果与一般人群中报告的糖尿病-心血管疾病等同风险概念一致。
