Association of diabetes with cardiovascular calcification and all-cause mortality in end-stage renal disease in the early stages of hemodialysis: a retrospective cohort study

• Published in: Cardiovascular diabetology Vol. 23; no. 1; pp. 259 - 13
• Main Authors: Li, Qingxian, Li, Peishan, Xu, Zigan, Lu, ZeYuan, Yang, Chuan, Ning, Jie
• Format: Journal Article
• Language: English
• Published: England BioMed Central 18.07.2024; BMC
• Subjects: Adult; Aged; Aorta; Calcification (ectopic); Cardiovascular calcification; Cardiovascular disease; Cardiovascular diseases; Cause of Death; Clinical outcomes; Coronary artery; Coronary Artery Disease - diagnosis; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary Artery Disease - therapy; Death; Decision Support Techniques; Diabetes; Diabetes mellitus; Diabetes Mellitus - blood; Diabetes Mellitus - diagnosis; Diabetes Mellitus - mortality; Diabetic Nephropathies - blood; Diabetic Nephropathies - diagnosis; Diabetic Nephropathies - mortality; Diabetic Nephropathies - therapy; End-stage renal disease; Fatalities; Female; Health risks; Hemodialysis; Humans; Kidney diseases; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - therapy; Male; Middle Aged; Mortality; Nomograms; Parathyroid hormone; Patients; Phosphorus; Prediction; Predictive Value of Tests; Renal Dialysis - mortality; Retrospective Studies; Risk Assessment; Risk Factors; Survival; The early stages of hemodialysis; Thorax; Time Factors; Treatment Outcome; Vascular Calcification - diagnostic imaging; Vascular Calcification - mortality; Cardiovascular calcification; Diabetes; The early stages of hemodialysis; Mortality; Prediction
• ISSN: 1475-2840; 1475-2840
• DOI: 10.1186/s12933-024-02318-8

The main goal of this study was to examine how diabetes, cardiovascular calcification characteristics and other risk factors affect mortality in end-stage renal disease (ESRD) patients in the early stages of hemodialysis. A total of 285 ESRD patients in the early stages of hemodialysis were enrolled in this research, including 101 patients with diabetes. Survival time was monitored, and general data, biochemical results, cardiac ultrasound calcification of valvular tissue, and thoracic CT calcification of the coronary artery and thoracic aorta were recorded. Subgroup analysis and logistic regression were applied to investigate the association between diabetes and calcification. Cox regression analysis and survival between calcification, diabetes, and all-cause mortality. Additionally, the nomogram model was used to estimate the probability of survival for these individuals, and its performance was evaluated using risk stratification, receiver operating characteristic, decision, and calibration curves. Cardiovascular calcification was found in 81.2% of diabetic patients (82/101) and 33.7% of nondiabetic patients (62/184). Diabetic patients had lower phosphorus, calcium, calcium-phosphorus product, plasma PTH levels and lower albumin levels (p < 0.001). People with diabetes were more likely to have calcification than people without diabetes (OR 5.66, 95% CI 1.96-16.36; p < 0.001). The overall mortality rate was 14.7% (42/285). The risk of death was notably greater in patients with both diabetes and calcification (29.27%, 24/82). Diabetes and calcification, along with other factors, collectively predict the risk of death in these patients. The nomogram model demonstrated excellent discriminatory power (area under the curve (AUC) = 0.975 at 5 years), outstanding calibration at low to high-risk levels and provided the greatest net benefit across a wide range of clinical decision thresholds. In patients with ESRD during the early period of haemodialysis, diabetes significantly increases the risk of cardiovascular calcification, particularly multisite calcification, which is correlated with a higher mortality rate. The risk scores and nomograms developed in this study can assist clinicians in predicting the risk of death and providing individualised treatment plans to lower mortality rates in the early stages of hemodialysis.