Cardiovascular complications in patients with diabetic nephropathy receiving pharmacological versus renal replacement therapy

Introduction. Diabetic nephropathy is a significant complication of diabetes mellitus and one of the major causes of renal replacement therapy. Cardiovascular complications are predominant causes of death in these patients. Objectives. To evaluate the influence of hemodialysis on cardiovascular risk factors and on their frequency in diabetic nephropathy patients. Patients and methods. 4 groups of renal failure patients were studied. Group 1 consisted of 71 hemodialyzed patients with non‑diabetic nephropathy. Group 2 consisted of 29 hemodialyzed patients with diabetic nephropathy. Group 3 consisted of 50 patients with renal failure in the predialysis period (glomerular filtration rate <60 ml/min). Group 4 consisted of 50 non‑dialyzed patients with diabetic nephropathy in the pre‑dialysis period. Complete blood count, blood gas, blood urea nitrogen, creatinine, glucose, lipidogram, electrolytes, parathormone, iron and dialysis adequacy (Kt/V) were assessed. Arterial blood pressure, resting ECG, echocardiography, body mass index, ankle–arm index, the prevalence of ischemic heart disease, myocardial infarction and chronic heart failure (NYHA classification) were also evaluated. Results. In hemodialyzed patients with diabetic nephropathy lower complete blood count, less severe calcium‑phosphate disorders, higher triglycerides and lower high-density lipoproteins cholesterol, with more frequent obesity, ischemic heart disease and peripheral arterial obstructive disease were found. Myocardial hypertrophy, cardiac arrhythmias, contractility disturbances, myocardial infarction and chronic heart failure were more common in the hemodialyzed patients, regardless of the cause of the renal disease. Conclusions. The risk factor for cardiovascular complications is greater in patients with diabetic nephropathy. Hemodialysis increases the frequency of cardiovascular complications in these patients and adversely affects the outcomes.