Diabetes and end-stage renal disease synergistically contribute to increased incidence of cardiovascular events: A nation-wide follow-up study during 1998-2009.

  1. Junne-Ming Sung, MD.1,5
  1. 1Department of Internal Medicine, National Cheng Kung University Hospital, Tainan;
  2. 2Graduate Institute of Clinical Medicine, National Cheng Kung University College of Medicine , Tainan, Taiwan;
  3. 3Biostatistics Consulting Center, National Cheng Kung University Hospital, Tainan, Taiwan;
  4. 4Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan;
  5. 5Department of Public Health, National Cheng Kung University College of Medicine, Tainan, Taiwan;
  6. 6Department of Environmental and Occupational Health, National Cheng Kung University Hospital, Tainan, Taiwan.
  1. Corresponding Author: Junne-Ming Sung, E-mail: jmsung{at}, Jung-Der Wang, E-mail: jdwang121{at}


Objective This study aimed to investigate the interaction of diabetes and end-stage renal disease (ESRD) on the risks of cardiovascular (CV) events.

Research Design and Methods By using two representative national cohorts, we determined the age- and sex-specific incidences, twenty-year risks of incident CV events, including acute myocardial infarction (AMI), stroke and congestive heart failure (CHF), stratified by the presence of diabetes, de novo diabetes after ESRD or ESRD. Individuals were excluded if aged below 18 years or the presence of previous CV events or malignancy before enrollment. Cox proportional hazard models were also constructed with adjustments for competing risk of mortality.

Results A total 648,851 non-ESRD individuals and 71,397 ESRD patients, including 53,342 and 34,754 diabetic patients respectively, were followed up during 1998-2009. A monotonic risk pattern of CV-related incidences was noted with the presence of diabetes, ESRD or both, respectively, after stratified by age and sex. De novo diabetes showed similar increased risks for CV incidences, especially AMI and stroke. There is a multiplicatively synergistic effect of diabetes and ESRD for CV related risks, especially for AMI and stroke, of which the adjusted hazard ratios (aHRs) [95% confidence intervals] were 5.24 [4.83-5.68] and 2.43[2.32-2.55], respectively in comparison with people without diabetes or ESRD; de novo diabetes after ESRD had similar effects with aHRs of 4.12[3.49-4.87] and 1.75[1.57-1.95], respectively.

Conclusions Diabetes and ESRD synergistically increase risks of CV events. Proactive screening and control for diabetes in patients with ESRD should be built into our daily practice.

  • Received April 1, 2013.
  • Accepted August 2, 2013.

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