Association of heart disease with diabetes and hypertension in patients with ESRD.

BACKGROUND: No published study has reported the combined effect of diabetes and hypertension on heart disease in patients with renal failure. We determined this effect by using data for all US adults who started renal replacement therapy from 1995 to 1999. METHODS: Data for patient characteristics, diabetes, hypertension, and heart disease were collected from the Medical Evidence Report, on which 6 cardiac conditions were recorded: congestive heart failure, ischemic heart disease, myocardial infarction, cardiac arrest, cardiac arrhythmia, and pericarditis. On the basis of diabetic-hypertensive status, we categorized patients into 4 groups: diabetes only, hypertension only, both diabetes and hypertension, and neither diabetes nor hypertension. Adjusting for age, sex, race-ethnicity, and incidence year with logistic regression, we estimated the likelihood of heart disease according to diabetic-hypertensive status. RESULTS: Of 373,539 patients, 49.8% had diabetes and 75.8% had hypertension; 11.4% had diabetes only, 37.4% had hypertension only, 38.4% had both diabetes and hypertension, and 12.8% had neither diabetes nor hypertension. Approximately 44% of patients (n = 163,570) had at least 1 condition, 19.4% had at least 2 conditions, and 6.5% had at least 3 of the 6 cardiac conditions. Logistic regression indicated that patients with diabetes only and hypertension only were 3.1 and 2.8 times more likely ( P < 0.0001) to have heart disease than those without diabetes and hypertension, respectively. Patients with both diabetes and hypertension were 5.9, 5.0, and 4.8 times more likely (P < 0.0001) to have at least 1, at least 2, and at least 3 cardiac conditions than those with neither diabetes nor hypertension, respectively. CONCLUSION: Patients with renal failure with both diabetes and hypertension are more likely to have heart disease than those with diabetes only and hypertension only.

Peritoneal and hemodialysis: I. Differences in patient characteristics at initiation.

BACKGROUND: Comparisons of mortality outcomes between peritoneal dialysis (PD) and hemodialysis (HD) patients have shown varying results, which may be caused by the unequally distributed clinical conditions of patients at initiation. To address this issue, we evaluated the clinical characteristics of 105,954 patients at the initiation of PD and HD, using the U.S. national incidence data on treated end-stage renal disease from the Medical Evidence Form, 1995 to 1997. METHODS: A general linear model was used to analyze differences of age, albumin, creatinine, blood urea nitrogen (BUN), and hematocrit; categorical data analysis to evaluate body mass index (BMI), grouped into four categories: < 19, 19-25 (< 25), 25-30 (< 30), and 30+; and logistic regression to assess the likelihood of initiating PD versus HD. Diabetics (DM) were analyzed separately from non-diabetics (NDM). Explanatory variables in the logistic regression included incidence year, race, gender, age, BMI, albumin, creatinine, BUN, and hematocrit. Race included white and black. Age was categorized into four groups: 20-44, 45-64, 65-74, and 75+. RESULTS: At the initiation of dialysis PD patients were approximately 6 years younger (P < 0.0001) than HD patients. PD patients also had higher (P < 0.0001) albumin (+0.35 g/dL for DM and +0.23 g/dL for NDM) and hematocrit (+1.64% for DM and +1.71% for NDM) levels, and lower (P < 0.04) BUN (-8.75 mg/dL for DM and -5.24 mg/dL for NDM) and creatinine (-0.51 mg/dL for DM and -0.23 mg/dL for NDM) levels than HD patients. Whites had a higher (P < 0.0001) likelihood of starting PD than blacks, and patients with BMI <19 had a lower (P < 0.0001) chance of beginning on PD. CONCLUSION: PD patients had favorable clinical conditions at the initiation of dialysis, which should be taken into consideration when comparing dialysis outcomes between the two modalities.