Impact of Diabetes on Cardiovascular Outcomes in Hemodialysis Patients Undergoing Coronary Revascularization
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概要
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Background: Among hemodialysis (HD) patients, those who have diabetes have poorer cardiovascular outcomes than non-diabetic patients, but the impact of diabetes on cardiovascular outcomes has not been fully elucidated in HD patients undergoing coronary revascularization. Methods and Results: We identified 375 HD patients (203 diabetes, 172 non-diabetes) and 9,006 patients without HD (3,455 diabetes, 5,551 non-diabetes) in the database of the CREDO-Kyoto registry of patients undergoing their first coronary revascularization. In non-HD patients, significantly higher risks of death (10.8% vs. 7.7%, P<0.0001; adjusted hazard ratio (HR) 1.29, P<0.0001) and major adverse cardiovascular events (MACE), a composite of death, myocardial infarction and stroke (18.8% vs. 13.3%, P<0.0001; HR 1.36, P<0.0001) were seen in diabetic patients than in non-diabetic patients through 4-year follow-up. Analysis in HD patients showed that the duration of HD before first coronary revascularization was significantly shorter in diabetic patients than in non-diabetic patients (median interval: 858 vs. 2,216 days, P<0.0001). In contrast to the results in non-HD patients, the risks of death (41.9% vs. 39.1%, P=0.75; HR 0.98, P=0.93) and MACE (45.6% vs. 45.8%, P=0.83; HR 0.87, P=0.50) after first revascularization were comparable between diabetic and non-diabetic HD patients. There were significant interactions between HD and diabetes for death and for MACE. Conclusions: HD patients who require coronary revascularization have extremely poor outcomes irrespective of concomitant diabetes. (Circ J 2011; 75: 1616-1625)
- 2011-06-25
著者
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Furukawa Yutaka
Kobe City Medical Center General Hospital
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Tanaka K
The First Department Of Internal Medicine Nippon Medical School
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Kudoh T
Department Of Cardiovascular Respiratory And Metabolic Medicine Graduate School Of Medicine Kagoshim
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Kudoh Takashi
Department Of Nuclear Medicine Kyoto University Faculty Of Medicine
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Kita Toru
Department Of Cardiovascular Medicine Graduate School Of Medicine Kyoto University
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Miyamoto Tadashi
Department Of Cardiology Hyogo Prefectural Amagasaki Hospital
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Morimoto Takeshi
神戸市立医療センター中央市民病院 循環器内科
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Sato Sumiko
Ehime Prefectural Central Hospital
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Nakagawa Yoshihisa
behalf of the j-Cypher Registry Investigators
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Kobayashi Takashi
Department Of Cardiology Kobe City Medical Center General Hospital
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Morimoto Tatsuya
Center For Medical Education Kyoto University Graduate School Of Medicine
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Nakagawa Yoshihisa
Department Of Cardiology Tenri Hospital
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Shizuta Satoshi
Department Of Cardiovascular Medicine Graduate School Of Medicine Kyoto University
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Kimura Takeshi
神戸市立医療センター中央市民病院 循環器内科
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Furukawa Yutaka
Department Of Cardiology Kobe City Medical Center General Hospital
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Kurata Takeshi
Department Of Cardiovascular Medicine Juntendo University School Of Medicine
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Morimoto Tatsuya
京都大学 医研究 循病態
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Morimoto Tatsuya
Division Of Translational Research Kyoto Medical Center
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Kotake Takeshi
国立循環器病センター 薬剤部
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Sunayama Satoshi
Department Of Cardiovascular Medicine Juntendo University School Of Medicine
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SUNAYAMA Satoshi
順天堂大学医学部 循環器内科
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Tamita Koichi
高木循環器科診療所 循環器科
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Kasai Takatoshi
順天堂大学 循環器内科学
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Kasai Takatoshi
Department Of Cardiology Juntendo University
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Miyamoto Tadashi
Department Of Cardiovascular Medicine Graduate School Of Medicine University Of Tokyo
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Kita Toru
National Hospital Organization And Department Of Cardiovascular Medicine Graduate School Of Medicine
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Nomura Masanori
on behalf of the j-Cypher Registry Investigators
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Ono Koh
Dep. Of Cardiovascular Medicine Graduate School Of Medicine Kyoto Univ. 54 Kawahara-cho Shogoin Saky
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Ono Koh
京都大学 医学研究科循環器内科学
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Ono Koh
Department Of Cardiovascular Medicine Graduate School Of Medicine Kyoto University
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Shioi Tetsuo
Department Of Cardiology And Internal Medicine Kitasato University School Of Medicine
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Shizuta Satoshi
Department Of Cardiology Juntendo Shizuoka Hospital
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Suwa Satoru
Jyuntendo Izu-nagaoka Hospital
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Suwa Satoru
Department Of Cardiology Juntendo University Shizuoka Hospital
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Tambara K
Department Of Cardiovascular Surgery Graduate School Of Medicine Kyoto University
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Miyamoto Tadashi
兵庫県立尼崎病院 循環器内科
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Morita Toshihiro
Department Of Cardiovascular Medicine Graduate School Of Medicine University Of Tokyo
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Miyamoto Tadashi
Center For Medical Education Kyoto University Graduate School Of Medicine
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Saito S
Department Of Cardiology Juntendo Shizuoka Hospital
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Kimura Takshi
京都大学 院放射線学
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Kadohira Tadayuki
虎の門病院循環器センター
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Saito Satoshi
日本大学 医学部循環器内科学
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Kita Toru
Department Of Cardiovascular Medicine Kyoto University Graduate School Of Medicine
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Kuwahara Taishi
Cardiovascular Center Yokosuka Kyosai Hospital
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Sakata Ryuzo
Department Of Cardiovascular Surgery Graduate School Of Medicine Kyoto University
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Kudou T
Kyoto Univ.
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Miura Aya
Dep. Of Cardiovascular Medicine Graduate School Of Medicine Dentistry And Pharmaceutical Sciences Ok
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Akao Masaharu
Department Of Cardiovascular Medicine Kyoto University Graduate School Of Medicine
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Kimura Takeshi
Department Of Cardiology Kobe City Medical Center General Hospital
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Suwa Satoru
Juntendo University Shizuoka Hospital
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Natsuaki Masahiro
Department Of Cardiology Saiseikai Fukuoka Hospital
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Kimura Takeshi
Department Of Respiratory Medicine Graduate School Of Medicine Kyoto University
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Suwa Satoru
Department Of Cardiology Juntendo Shizuoka Hospital
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Marui Akira
Department Of Cardiovascular Medicine Graduate School Of Medicine Kyoto University
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Tanno Kaoru
Division Of Cardiology Kobe City Medical Center General Hospital
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AKAO Masaharu
Division of Cardiology,Shizuoka City Hospital
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Furukawa Yutaka
Department Of Biochemistry And Molecular Biology Saitama University
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Kudoh T
Department Of Cardiovascular Medicine Graduate School Of Medicine Kyoto University
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Kimura Takeshi
Department Of Cardiovascular Medicine
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Koyama Takashi
Department Of Diagnostic Imaging And Nuclear Medicine Kyoto University Graduate School Of Medicine
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SUWA Satoru
Division of Cardiology, Department of Medicine, Juntendo school of Medicine
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Tanaka Keiji
Intensive And Cardiac Care Unit Nippon Medical School
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Kawamura Teruhisa
Division Of Translational Research Kyoto Medical Center
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Shirakawa Ryutarou
Department Of Cardiovascular Medicine Kyoto University
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Matsumori Akira
The Third Devision Department Of Internal Medicine Kyoto University
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Marui Akira
Department Of Cardiovascular Surgery Kyoto University Graduate School Of Medicine
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Matsumori A
The Third Division Department Of Internal Medicine Kyoto University And Department Of Medicine Beth
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Shizuta Satoshi
Department Of Cardiovascular Medicine Keiai Hospital
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Tamita Kouichi
The Department Of Cardiology Kobe General Hospital
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Morimoto Takeshi
Kyoto University Hospital
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Kimura Takeshi
Department Of Cardiovascular Medicine Kyoto University Hospital
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Nasu Michihiro
Division Of Thoracic Surgery Kobe City Medical Center General Hospital
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Tanno Kaoru
Department Of Cardiology Kobe City Medical Center General Hospital
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Saito Satoshi
Department Of Cardiovascular Medicine Keiai Hospital
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Ono Koh
Department Of The Cardiovascular Medicine Kyoto University School Hospital
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Koyama Takashi
Cardiovascular Division Institute Of Clinical Medicine Graduate School Of Comprehensive Human Scienc
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Morimoto Takeshi
Center For Medical Education Graduate School Of Medicine Kyoto University
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Miyoshi Takashi
Department Of Cardiovascular Medicine Graduate School Of Medicine University Of Tokyo
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Matsumori Akira
Japanese Circulation Society Guideline Preparation Group Myocarditis
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Tamita Koichi
Department Of Cardiology Kobe City Medical Center General Hospital
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Katagiri Takashi
Department Of Cardiology Kobe City Medical Center General Hospital
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Takahashi Ken-ichi
Department Of Respiratory Medicine Otsu Red Cross Hospital
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Okabayashi Hitoshi
Department Of Cardiovascular Surgery Iwate Medical University
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Okabayashi Hitoshi
Department Of Cardiology Thoracic Surgery
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Kita Toru
Department Of Cardiovascualr Medicine Kyoto University Graduate School Of Medicine
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Nasu Michihiro
Department Of Thoracic And Cardiovascular Surgery Kobe General Hospital
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Nishiwaki Noboru
Department Of Cardiovascular Surgery Kokura Memorial Hospital.
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Nishiwaki Noboru
Nara Hospital Kinki University School Of Medicine
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Kudoh Takashi
Department Of Cardiovascular Medicine Kyoto University Graduate School Of Medicine
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Katoh Takao
Department Of Disease Control And Homeostasis Graduate School Of Medical Science Kanazawa University
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Kudoh Takashi
Department Of Respiratory Medicine Otsu Red Cross Hospital
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Morota Tetsuro
Department Of Cardiothoracic Surgery And Human Pathology The University Of Tokyo Graduate School Of
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Saito Satoshi
Department Of Advanced Medical Science Nihon University School Of Medicine
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Ono Koh
National Hospital Organization And Department Of Cardiovascular Medicine Graduate School Of Medicine
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Ono Kou
Department Of Cardiovascular Medicine Kyoto University Hospital
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Kodama Tatsuhiko
Laboratory For Systems Biology And Medicine Research Center For Advanced Science And Technology The
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Nakagawa Yoshihisa
Division Of Cardiology Tenri Hospital
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KOMIYA Tatsuhiko
Department of Cardiovascular Surgery, Kurashiki Central Hospital
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Akao Masaharu
Division Of Cardiology Kyoto Medical Center National Hospital Organization
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Kudoh Takashi
Department Of Cardiology Kobe City Medical Center General Hospital
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Komiya Tatsuhiko
Department Of Cardiovascular Surgery Kurashiki Central Hospital
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Kawamura Teruhisa
Division Of Translational Research Kyoto Medical Center National Hospital Organization
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Arai Masazumi
Division Of Cardiology Kyoto Medical Center National Hospital Organization
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Kimura Takeshi
Department Of Respiratory Medicine Otsu Red Cross Hospital
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Saito Satoshi
Department Of Cardiovascular Of Medicine Graduate School Of Medicine Kyoto University
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Togashi Kaori
Kyoto Univ. Hospital Kyoto Jpn
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Marui Akira
Division Of Cardiology Kyoto Medical Center National Hospital Organization
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Sakata Ryuzo
Department Of Cardiovascular Surgery Division Of Bioinformatics And Chemical Genomics Graduate Schoo
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Kita Toru
Division Of Translational Research Kyoto Medical Center National Hospital Organization
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Toma Masanao
Department Of Cardiology Hyogo Prefectural Amagasaki Hospital
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Akao Masaharu
Division Of Cardiology Kyoto Medical Center
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Koyama Takashi
Cardiovascular Division Institute Of Clinical Medicine Graduate School Of Comprehensive Human Scienc
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Saito Satoshi
Department Of Medicine Division Of Cardiovascular Medicine Nihon University School Of Medicine
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Shirakawa Ryutaro
Department Of Cardiovascular Medicine Graduate School Of Medicine Kyoto University
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KIYOOKA Takahiko
Tokai University Hachioji Hospital
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Nishiwaki Noboru
Department Of Cardiovascular Surgery Kinki University Graduate School Of Medicine Nara Hospital
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MORIMOTO Takeshi
Center for General Internal Medicine and Emergency Care, Kinki University School of Medicine
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KIMURA Takeshi
Department of Applied Chemistry and Molecular Science, Faculty of Engineering, Iwate University
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Okabayashi Hitoshi
Department of Cardiac Surgery, Iwate Medical University
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