Echocardiographic Evidence of Altered Cardiac Status in Predialysis Diabetics and Those on Dialysis

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Abstract:

Cardiovascular complications affect diabetic subjects early and the more susceptible ones are those on hemodialysis. Objective: 

This study was designed to observe prevalent cardiac involvement in both pre- and already on dialysis diabetics. Method: 

Sixty diabetics, 30 predialysis (predialysis diabetics, group 1), and 30 on maintenance hemodialysis (MHD, group 2) were randomly selected and their different clinical, biochemical, and echocardiographic parameters were compared. Result: 

Both groups of patients were matched for age, sex, and body mass index (BMI). Features like systolic and diastolic blood pressure were lower in predialysis diabetics group than in MHD group [138 ± 19 vs. 152 ± 32, p < 0.02 and 74 ± 10 vs. 87 ± 10 mmHg (p < 0.001)]; hemoglobin higher [10.3 ± 2.1 vs. 7.5 ± 1.5 g/dL (p < 0.001)]; serum creatinine was lower [3.49 ± 1.8 vs. 9.5 ± 2.5 mg/dL (p < 0.001)] (due to recruitment criteria); left ventricular muscle mass index (LVMI) also lower [137 ± 96 vs. 211 ± 77 g/m2 (p < 0.001)]; left ventricular end diastolic volume index (LVEDVI) less [58 ± 21 vs. 85 ± 25 mL/m2 (p < 0.001) and fractional shortening (FS, %) higher [33 ± 4.3 vs. 28 ± 5.8 (p < 0.006)]. Only 11% of Pre subjects had LV hypertrophy (LVMI >131 g/m2 in male and in female LVMI >110 g/m2) whereas it was 51% in MHD (p < 0.001). Systolic dysfunction (FS = <25%) was 4% in Pre subjects and 24% in MHD (p < 0.03) group. Correlation study showed systolic and diastolic blood pressure; both had positive correlation with LVMI (r = 0.38, p < 0.008 and r = 0.32, p < 0.02) and LVEDVI (r = 0.36, p < 0.01 and r = 0.35, p < 0.01) and also similarly positive with serum creatinine (r = 0.35, p < 0.02 and r = 0.5, p < 0.001). Conclusion: 

It may be concluded that cardiac parameters are grossly altered in majority of diabetics on dialysis and higher serum creatinine and uncontrolled blood pressure may be responsible for this.

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1492-7535.2004.0085av.x

Affiliations: 1: Department of Nephrology, SSMC & Mitford Hospital 2: BSM Medical University 3: BIRDEM, Dhaka, Bangladesh

Publication date: January 1, 2004

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