Attaining Long-Term Survival When Treating Diabetic Patients With ESRD by Hemodialysis

Introduction: We analyzed the national Veteran Affairs (VA) data to evaluate the association of preoperative glycated Hemoglobin (HbA1c) and long-term outcome after isolated coronary artery bypass grafting (CABG). Methods: Between January 2007 - December 2014, Veterans with diabetes mellitus (DM) that underwent isolated CABG were divided on into three groups (I: HbA1c < 8%, II: HbA1c 8 - 10% and III: HbA1c > 10%). Demographic and clinical differences between groups were evaluated with the t-test or chi-square test. The relationship of preoperative HbA1c and long-term survival was evaluated with a multivariable proportional hazards model; restricted cubic splines were used to model non-linear effects. The cumulative incidence of secondary end-points (myocardial infarction, urgent revascularization) for each group was modeled as a competing-risk analysis. Results: Overall, 3,210 patients (mean age 64.6 years, male 98.8%; insulin dependent - 53%) with DM underwent isolated CABG. Group III patients were younger (61 vs 65 years in group I). Median HbA1c levels were similar between races (white - 7.3% and blacks - 7.35%). Insulin dependence was higher in group III (79.3%) vs groups I (43.5%) and II (69.9%). In groups I,II and III, 5 and 10 year survival was 76.2%, 74.4%, 75.4% and 38.9%, 36.9% and 30.2% respectively. HbA1c was observed to have a J-shaped association with mortality with values < 6% and > 9% at higher risk of death. Left ventricular systolic dysfunction [HR 1.5 (1.3 - 1.7)], prior myocardial infarction [HR 1.3 (1.2 - 1.5)] and insulin dependence [HR 1.4 (1.2 - 1.5)] were also associated with lower survival. Myocardial infarction was observed in 9.8% , 13.4% and 12.8% patients in groups I, II and III respectively. Conclusions: Pre-operative HbA1c impacts long-term survival among diabetic patients undergoing CABG. We observed a J-shaped relationship between HbA1c and survival with values < 6% and > 9% associated with increased mortality.

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Improved Long-Term Survival for Diabetic Patients With Surgical Versus Interventional Revascularization

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2014.11.035 ◽

2015 ◽

Vol 99 (4) ◽

pp. 1298-1305 ◽

Cited By ~ 8

Author(s):

Paul Kurlansky ◽

Morley Herbert ◽

Syma Prince ◽

Michael J. Mack

Keyword(s):

Diabetic Patients ◽

Term Survival ◽

Long Term Survival

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LONG- TERM SURVIVAL AFTER KIDNEY AND KIDNEY AND PANCREAS TRANSPLANTATION IN DIABETIC PATIENTS

Transplantation Journal ◽

10.1097/00007890-200308271-00139 ◽

2003 ◽

Vol 76 (Supplement) ◽

pp. S64

Author(s):

E. Orsenigo ◽

M. Cristallo ◽

C. Socci ◽

P. Fiorina ◽

E. La Rocca ◽

...

Keyword(s):

Pancreas Transplantation ◽

Diabetic Patients ◽

Term Survival ◽

Long Term Survival

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Outcome and long term survival in diabetic patients after coronary surgery

European Journal of Anaesthesiology ◽

10.1097/00003643-200219271-00098 ◽

2002 ◽

Vol 19 (Supplement 27) ◽

pp. 33

Author(s):

Z. Szabó ◽

R. Svedjeholm ◽

E. Håkanson

Keyword(s):

Diabetic Patients ◽

Coronary Surgery ◽

Term Survival ◽

Long Term Survival

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Long-Term Survival Outcomes after Coronary Artery Revascularization Surgery of Bangladeshi Population: A Single Centre Study

Ibrahim Cardiac Medical Journal ◽

10.3329/icmj.v9i1-2.53982 ◽

2020 ◽

Vol 9 (1-2) ◽

pp. 8-15

Author(s):

Rezaul Karim ◽

Masoom Siraj ◽

Md Nurul Amin ◽

Mohammad Abdur Rashid ◽

Hemanta I Gomes ◽

...

Keyword(s):

Heart Disease ◽

Coronary Artery ◽

Hospital Stay ◽

Survival Outcomes ◽

Diabetic Patients ◽

Term Survival ◽

Long Term Survival ◽

Cabg Surgery ◽

Cabg Patients

Background & objective : Coronary artery bypass graft (CABG) surgery has given symptomatic and structural release of coronary atherosclerotic heart disease. CABG has been performed frequently for more than 30 years in Bangladesh. But there are no nationwide studies on the rate of survival in Bangladesh. The present study was undertaken to find the post CABG surgery survival outcomes and association between risk factors and survival over long time span. Methods: We studied 650 consecutive patients’ post-operative clinical data retrospectively and survival outcome data were collected prospectively who had CABG surgery from 2010 to 2015 in Ibrahim Cardiac Hospital & Research Institute. Of the 650 patients, 84(12.9%) died after a median follow up of 4.9 years. Demographic, clinical, operative and postoperative characteristics were then compared between survived and died patients to find the factors associated with survival. Result: Analysis revealed that younger patients were more likely to survive [RR = 1.1(95% CI = 1.0-1.2)] longer than those who have had their CABG at or > 55 years (p = 0.001). Males generally had a higher likelihood of survival [RR = 1.1(RR = 1.1(95% CI = 0.9-1.2)] than their female counterparts (p = 0.038). Non-diabetics tend to have a better survival [RR = 2.3(95% CI = 1.3-3.9)] than diabetics (p = 0.001). Non-smokers also have a higher chance of longer survival [RR = 1.5(95% CI = 0.9-2.2)] than the smokers. CABG patients without CKD enjoyed longer survival [RR = 1.4(95% CI = 0.9-2.2)] than CABG patients with CKD (p = 0.006). None of the operative and postoperative factors but hospital stay was associated with longer survival. The survived patients had a shorter mean hospital stay than the patients who died (p = 0.001). Analyses of the causes of death revealed heart disease to be the predominant cause (38%) followed by stroke (12%), CKD (8%) and other causes like cancer, liver disease etc. (42%). Conclusion: Younger, male, non-smoker, non-diabetic patients may enjoy long-term survival following CABG surgery. Prediction of long-term survival can be used to determine the most appropriate post-discharge care strategies. This would undoubtedly help both patients and doctors to implement behavioral and therapeutic modifications to optimize benefit from surgery. Ibrahim Card Med J 2019; 9 (1&2): 8-15

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Comparison of Long-Term Survival (Beyond 12 Years) in Patients on Peritoneal Dialysis and on Hemodialysis

Peritoneal Dialysis International ◽

10.1177/089686080302302s22 ◽

2003 ◽

Vol 23 (2_suppl) ◽

pp. 104-108 ◽

Cited By ~ 1

Author(s):

Kai-Chung Tse ◽

Sing-Leung Lui ◽

Wai-Kei Lo

Keyword(s):

Cardiovascular Disease ◽

Peritoneal Dialysis ◽

Bone Disease ◽

Left Ventricular ◽

Diabetic Patients ◽

Renal Unit ◽

Term Survival ◽

Long Term Survival

Objective We investigated the clinical condition and complications of patients on peritoneal dialysis (PD) and on hemodialysis (HD) for more than 12 years. Design This retrospective review was carried out in the renal unit of the Tung Wah Hospital, Hong Kong. Patients and Methods Of 103 HD and 341 PD patients who started dialysis before 1990, 14 HD and 22 PD patients were dialyzed for more than 12 years. We evaluated basic demography at the 12th year of dialysis and at the most recent follow-up, and assessed the prevalence of cardiovascular disease, bone disease, dialysis-related amyloidosis (DRA), and acquired cystic disease (ACD). Outcomes and mortality were recorded. Results The 36 patients in the study included 22 women and 14 men. The PD patients were older ( p = 0.021) and had lower levels of serum phosphate and calcium × phosphate product. Only 3 patients were diabetic. Cardiovascular disease was present in 30 patients (83.3%), the most common types being ischemic heart disease (IHD, n = 11) and left ventricular hypertrophy (LVH, n = 22). Symptomatic DRA was found in 13 patients (36.1%), more commonly in the HD group ( p = 0.014). Bone disease was present in 32 patients (88.9%), with parathyroidectomy being more frequently performed in the PD patients ( p = 0.048). Symptomatic ACD occurred in 5 patients (13.9%). At the most recent follow-up, 26 patients were still on dialysis, 3 patients had undergone renal transplantation, and 7 patients had died, the causes of death being sudden death ( n = 3), cerebrovascular accident ( n = 1), chest infection ( n = 2), and peritonitis ( n = 1). Patient survival was similar in the PD and HD groups. Age at commencement of dialysis predicted mortality ( p = 0.012), but mode of dialysis, sex, and presence of diabetes mellitus did not. Conclusions Long-term survival is possible for both dialysis modalities (PD and HD), particularly for young, non diabetic patients. Symptomatic DRA is less common in PD patients, but the prevalence of other long-term complications is similar for both groups. Cardiovascular-related problems remain the leading cause of death.

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