Does short-term dialysis significantly increase coronary artery disease burden in diabetic patients who undergo renal transplantation?

Abstract

Background: Although preemptive renal transplantation decreases mortality associated with dialysis, coronary artery disease (CAD) remains the primary cause of mortality even after transplantation in patients with diabetes. We sought to determine whether short-term dialysis treatment significantly impacts CAD burden, revascularization strategy, and all-cause long-term mortality in diabetic renal transplant (RT) recipients without prior CAD. Subjects and Methods: Diabetic patients with end-stage renal disease and without prior CAD who were referred to coronary angiography before renal transplantation were retrospectively included. These patients were then divided into two groups as short-term dialyzed (nonpreemptive) and preemptive group. Angiographic findings, the severity of CAD, and long-term mortality were compared between the groups. Results: Overall, 164 included patients were included, of whom 125 (78%) were male, and the median age was 54 years (Q1–Q3 = 45–59). The mean duration of dialysis before RT was 1 year (range, 0.5–1.5 years) in the nonpreemptive group. The extent of CAD, revascularization rates, SYNTAX, and Gensini scores were similar between groups (all P > 0.05). During 4.8 years of follow-up, there were no significant differences in major adverse cardiovascular and cerebrovascular events ([hazard ratio (HR) = 0.88 (0.38–2.01), P = 0.76]) and all-cause mortality rates ([(HR) = 0.59 (0.20–1.71), P = 0.33]). Only age and hyperlipidemia were predictive of all-cause mortality (HR = 1.03 [1.001–1.07], P = 0.04 and HR = 2.75 [1.20–6.28], P = 0.01, respectively). Conclusion: Short-term dialysis does not seem to increase newly diagnosed CAD prevalence and burden in diabetic patients undergoing renal transplantation compared to patients who directly undergo renal transplantation. Moreover, long-term all-cause mortality rates did not differ between the two groups as well. Age and hyperlipidemia were independent predictors of all-cause mortality