Serum Lipids Predict Cardiac Death in Diabetic Patients on Maintenance Hemodialysis

Abstract

The objective of this study was to measure cholesterol concentrations in diabetic patients at the beginning of maintenance hemodialysis treatment and to define their role as predictors of subsequent cardiac death on maintenance hemodialysis. The design of this study consisted of a prospective study of all consecutive diabetic patients newly admitted to 28 German dialysis centers between January 1985 and October 1987. The patients were examined on admission and subsequently followed for 45 months on dialysis. This study included 196 patients, 67 type I (43 male, 24 female, median age 49 years, range 22-73) and 129 type II (54 male, 75 female, aged 64 years, range 37-82). Lipids (total cholesterol, triglycerides low-density lipoprotein (LDL) cholesterol high-density lipoprotein (HDL) cholesterol apolipoprotein B and A and anthropometric indices (body mass index, triceps skinfold thickness) were measured. The outcome was death, i.e., cardiovascular (myocardial infarction, sudden death, other cardiac causes, stroke) and noncardiovascular death during a 45-month follow-up. At the start of treatment, total cholesterol, triglycerides LDL cholesterol, LDL/HDL ratio and apolipoprotein B were significantly higher in diabetics than in healthy controls or patients with standard primary renal disease starting dialysis. Only minor differences were found between males and females and type I and type II diabetics. Fourty-three percent of type I and 50% of type II diabetics died, 61% from cardiovascular causes, mostly myocardial infarction (in 40% reinfarction) and sudden death. On admission, diabetics subsequently dying from myocardial infarction had significantly higher median cholesterol than survivors, i.e., 259 versus 222 mg/dl, and higher LDL cholesterol, LDL/HDL ratio and apolipoprotein B. The conclusion of this study is that high cholesterol is a potent predictor of cardiac death in uremic diabetics treated by maintenance hemodialysis. Controlled trials on the effects of lipid-lowering treatment are desirable.

Randomized Controlled Trial on the Efficacy and Safety of Atorvastatin in Patients with Type 2 Diabetes on Hemodialysis (4D Study): Demographic and Baseline Characteristics

“…Furthermore, a large number of centers (n = 178) throughout Germany participate in the study, ruling out a center effect. The lipid levels, in particular mean LDL cholesterol (126 mg/dl) and triglycerides (264 mg/dl), were slightly lower than expected, but were comparable to those of previous, smaller studies in this population and geographical area [35,36]. Studies performed in other geographical regions showed higher baseline levels for LDL cholesterol [23].…”

“…Moreover, the composition of the LDL is altered, showing a high proportion of dense LDL [2,41,42]. On the basis of results of previous studies, we expected that our patients would exhibit an LDL cholesterol level at baseline in the range from 140 to 160 mg/dl and fasting triglyceride concentrations ranging between 200 and 300 mg/dl [35,36]. According to recent evidence, such moderate forms of dyslipoproteinemia may still warrant statin therapy in patients at a high global risk of cardiovascular events.…”

“…To achieve this, at least 424 patients had to have a primary end point, which required at least 1,200 patients to be randomized. This calculation was based on data from previous findings [35,36]. The analysis of the study is based on intention to treat.…”

Renal Replacement Therapy in Uremic Diabetic Patients – Experience from The Republic of Macedonia

“…In a prospective study (29), a relationship between coronary risk and cholesterol concentrations in diabetics admitted for haemodialysis has been established.…”

Avaliação crítica do sevelamer no tratamento da hiperfosfatemia em pacientes com insuficiência renal crônica

“…Os benefícios relativos da modificação do perfil lipídico nos pacientes com IRC ainda são desconhecidos. Concentrações elevadas de colesterol sérico foram preditivas de óbito em pacientes com IRCT e diabetes 38 . Anormalidades de lipídios em pacientes em diálise podem contribuir para o risco aumentado de aterosclerose coronariana e em outros leitos vasculares 39 .…”