Impact of chronic kidney disease on prognosis of patients with diabetes mellitus treated with percutaneous coronary intervention

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Abstract

Chronic kidney disease (CKD) is a frequent complication of diabetes mellitus. However, the role of CKD in outcomes of patients with diabetes who have undergone percutaneous coronary intervention (PCI) has not been studied specifically. Therefore, we investigated the impact of CKD on prognosis of patients with diabetes who underwent PCI. Of 1,575 diabetic patients who underwent PCI, 1,046 (66%) had preserved renal function, 492 (31%) had CKD (baseline serum creatinine >1.5 mg/dl or estimated glomerular filtration rate <60 ml/min/1.73 m2) without dialysis, and 37 (2.3%) were dependent on dialysis. Patients with CKD versus those without CKD had more in-hospital complications, including mortality (2.6% vs 0.5%, respectively; p <0.0001), neurologic events (3.1% vs 0.6%, p = 0.0001), and gastrointestinal bleeding (2.9% vs 0.9%, p = 0.01). Contrast-induced nephropathy after PCI (increase ≥25% and/or ≥0.5 mg/dl of serum creatinine before PCI vs 48 hours after PCI) was found in 15% of patients without CKD versus 27% of those with CKD, and de novo dialysis was instituted in 0.1% versus 3.1%, respectively. Contrast-induced nephropathy was independently predicted (all p <0.0001) by peri-PCI hypotension (odds ratio [OR] 2.62), insulin treatment (OR 1.84), and volume of contrast medium (OR 1.30). The 1-year mortality rate was strikingly higher (all p <0.0001) in patients with CKD who did not receive dialysis (16%) and those on dialysis (44%) compared with the group with preserved renal function (5%). Contrast-induced nephropathy was among the independent predictors of a 1-year mortality rate (OR 2.75, p <0.001).

Section snippets

Study population

The study is based on patients with diabetes who underwent native-vessel PCI over a 6-year period at a single tertiary care center. Patients treated with PCI for acute myocardial infarction and patients known to have neoplastic disorders were excluded. Data collection and analysis have been described previously.3 Information on 1-year outcomes was obtained from telephone interviews by experienced research nurses. All adverse events were source documented. The study was approved by the

Results

Of 1,575 patients with diabetes treated with PCI, 1,046 (66%) had preserved renal function, 492 (31%) had CKD not requiring dialysis, and 37 (2.3%) were dependent on dialysis.

Compared with patients with preserved renal function (Table 1), those with CKD but not on dialysis were older and more frequently women and had a smaller body surface area and lower left ventricle ejection fractions (p = 0.005 to p <0.0001). In addition, hypertension, advanced congestive heart failure, peripheral arterial

Discussion

In this study, 33% of patients with medically treated diabetes who underwent PCI had CKD. CKD was associated with significantly worse short- and long-term outcomes. Compared with patients with preserved renal function, those with CKD not on dialysis had 5 times higher in-hospital rates of mortality and neurologic complications, 3 times higher rates of pulmonary edema and gastrointestinal bleeding, and a significantly prolonged in-hospital stay. One-year survival rate in patients with CKD was 3

Acknowledgements

The investigators are grateful to Yingbo Na, MSc, for statistical review of this report.

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