The Relationship between Early Vascular Access Failure and Cardiovascular Mortality in Hemodialysis Patients with Diabetes Mellitus.
- Author:
Young Ok KIM
1
;
Sun Ae YOON
;
Ho Cheol SONG
;
Ki Hoon HUR
;
Chul Woo YANG
;
Dong Chan JIN
;
Yong Soo KIM
;
Suk Young KIM
;
Euy Jin CHOI
;
Yoon Sik CHANG
;
Byung Kee BANG
Author Information
1. Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. sayoon@catholic.ac.kr
- Publication Type:Original Article
- Keywords:
Diabetes mellitus;
Hemodialysis;
Vascular access failure;
Cardiovascular mortality
- MeSH:
Diabetes Mellitus*;
Follow-Up Studies;
Heart Failure;
Humans;
Incidence;
Male;
Mortality*;
Myocardial Infarction;
Peripheral Arterial Disease;
Renal Dialysis*;
Retrospective Studies
- From:Korean Journal of Nephrology
2003;22(4):397-404
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Although the exact mechanism in which vascular access failure frequently occurs in hemodialysis patients with diabetes mellitus is not well known, it is considered to be associated with the poor quality of the vessel at the vascular access operation sites. Therefore, vascular access failure may be associated with cardiovascular mortality in the diabetic patients, but it is not reported yet. We studied the impact of early vascular access failure on the cardiovascular morbidity in the hemodialysis patients with diabetes mellitus. METHODS: This retrospective study enrolled 144 patients who received vascular access operation between January, 1995 and December, 2000 at Uijongbu St. Mary's Hospital. We investigated vascular access failure within 1 year after the access operation and evaluated the cardiovascular death until December, 2002. We analyzed the cardiovascular mortality between early vascular failure group and patent group using Kaplan-Meier method and log rank test. RESULTS: The mean age of the patients was 58+/-11 years and the number of male was 57 (39.6%). Early vascular access failure developed in 68 patients (47.2%). During 32+/-20 months of mean follow-up period, there was 62 cardiovascular deaths. The follow-up period tended to be shorter in the access failure group (n=68) than the patent group (n= 76) (29+/-17 months vs 35+/-22 months, p=0.07). But the access failure group had higher incidence of acute myocardial infarction (13.2% vs 3.9%, p=0.044), congestive heart failure (70.5% vs 13.1%, p< 0.001), and peripheral arterial disease (20.5% vs 3.9%, p= 0.002), compared to the patent group. The cardiovascular mortality of the access failure group was higher than that of the patent group (3 year; 54.6% vs 24.6%, 5 year; 77.0% vs 42.3%, p=0.005). CONCLUSION: This data suggest that early vascular access failure is associated with the cardiovascular morbidity and mortality in hemodialysis patients with diabetes mellitus.
