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Electrocardiography and Outcome in Patients with Diabetes Mellitus on Maintenance Hemodialysis

Vera Krane^*, Fritz Heinrich, Malte Meesmann, Manfred Olschewski, Jürgen Lilienthal^||, Christiane Angermann^*, Stefan Störk^*, Johann Bauersachs^*, Christoph Wanner^*, Stefan Frantz^*; for the German Diabetes and Dialysis Study Investigators

^* University Clinic, Department of Medicine, Divisions of Cardiology and Nephrology, University of Würzburg, Würzburg, Germany; Community Hospital Bruchsal, Bruchsal, Germany; Stiftung Juliusspital Krankenhaus, Würzburg, Germany; Department of Medical Biometrics and Statistics, University Hospital of Freiburg, Freiburg, Germany; and ^|| DATAMAP GmbH, Freiburg, Germany

Correspondence: Dr. Vera Krane, University of Würzburg, Department of Medicine, Division of Nephrology, University Clinic, Josef-Schneider-Str. 2, D-97080 Würzburg, Germany. Phone: +49-931-201-36331; Fax: +49-931-201-36502; E-mail: krane_v{at}medizin.uni-wuerzburg.de

Background and objectives: In hemodialysis, applicable guidelines recommend regular electrocardiogram (ECG) recordings. However, respective systematic evaluations are absent. Thus, the authors investigated whether routine ECG findings add prognostic information to standard risk assessment in hemodialysis.

Design, setting, participants, & measurements: The relationship between nine common baseline ECG variables and a combined cardiovascular endpoint (CVE; cardiac death, myocardial infarction, stroke), sudden death, stroke, MI, and all-cause death in 1253 patients from the German Diabetes and Dialysis Study was evaluated. All patients were on maintenance hemodialysis, had type 2 diabetes mellitus, and received randomized treatment with atorvastatin or placebo.

Results: During 4 yr of follow-up (March 1998 to March 2004), 469 patients reached the CVE, and 617 died. After adjustment for demographics, comorbidities, and biomarkers in multivariate analysis, patients presenting without sinus rhythm were 89% more likely to die, and the risk of CVE and stroke increased by 75% and 164%, respectively, compared with patients with preserved sinus rhythm. Left ventricular hypertrophy was associated with >2-fold increase in the risk of stroke and a 60% increase in the risk of sudden death.

Conclusions: In hemodialysis patients with type 2 diabetes mellitus, the absence of sinus rhythm is a risk indicator for CVE, stroke, and all-cause death, and left ventricular hypertrophy is associated with stroke and sudden death. Thus, routine ECG recording adds prognostic information to standard risk assessment.

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