Left ventricular morphology and function in diabetic and nondiabetic hemodialyzed patients

Abstract

Morbidity in end-stage renal disease (ESRD) diabetic patients is worse than in patients without diabetes mellitus (DM). This study aims to compare clinical, laboratory, and echocardiographic features between the ESRD patients with and without DM. Fifty-eight ESRD patients on dialysis were prospectively divided into two groups according to the presence of DM. Demographic, clinical, laboratory, and echocardiographic features (ejection fraction and wall motion score index) were compared between the two groups. Overall, 20 out of 58 patients (37.8%) with ESRD had DM. There were no significant differences between the patients with DM and those without DM when it comes to age (60.6 ± 10.6 vs. 59.0 ± 10.6 years, P = 0.665), ejection fraction (52.6% ± 12.8% vs. 54.2% ± 12.8%, P = 0.59), and wall motion score index (1.21 ± 0.3 vs.1.15 ± 0.3, P = 0.37). In multivariant analysis of the interventricular septum, posterior wall thickness and left atrium size correlated positively with DM. There was also no statistical difference in myocardial perfusion disturbances on real-time contrast echocardiography between the groups with and without DM (12 (60%) patients vs. 14 patients (36.8%), P = 0.079). Among diabetics 77.8% had significant atherosclerotic changes, while in the group without DM, only 38.1%, P = 0.01. From the laboratory parameters ferritin and high-sensitivity C-reactive protein levels were significantly higher in the group with DM, P = 0.014 and P = 0.026, respectively. Patients with ESRD and DM have significantly bigger left atrial size, thicker left ventricular walls, and higher serum ferritin and high-sensitivity C-reactive protein levels than the patients without DM. The aforementioned features may be possible risk factors for the development of adverse cardiac events in patients on hemodialysis.

Vascular adhesion protein-1 in hemodialysis and hemodiafiltration patients: effect of single hemodialysis session on its level in regard to type of anticoagulant

“…Ferritin was one of the predictors of VAP-1 in our population. Being the acute-phase reactant, not only the iron storage protein [17], ferritin, paralleled VAP-1 levels in diabetic dialyzed patients [18]. …”

Cardiovascular disease and kidney transplantation‑evaluation of potential transplant recipient

“…In our previous study, we found a high percentage of pathological changes such as left ventricular hypertrophy and ST-T interval abnormalities. 34 Survival of hemodialyzed diabetic patients was not inferior to that in nondiabetics; however, morbidity was significantly higher owing to adverse cardiac events. 35 After comparing all analyzed features on ECG between diabetic and nondiabetic patients, we did not reveal any significant differences.…”

“…Left ventricular hypertrophy is frequently seen in hemodialysis patients. Tomaszuk--Kazberuk et al 34 reported that patients with ESRD and diabetes have significantly larger left atrial size, thicker left ventricular walls, and higher ferritin levels than those without diabetes. The limitation of the stress test is its difficulty in achieving target metabolic activity and heart rate limit.…”