Anti-Hyperglycemic Agents and New-Onset Acute Myocardial Infarction in Diabetic Patients with End-Stage Renal Disease Undergoing DialysisReport as inadecuate




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Background

Diabetes and chronic kidney disease CKD are a high-stakes combination for cardiovascular disease. Patients with decreased kidney function and end-stage renal disease ESRD have increased risk of hypoglycemia when attaining better glycemic control, leading to higher risk of myocardial infarction MI. For these patients, which kinds of anti-hyperglycemic agents would be associated with higher risk of MI is not clear.

Methods

We identified patients from a nation-wide database called Registry for Catastrophic Illness, which encompassed almost 100% of the patients receiving dialysis therapy in Taiwan from 1995 to 2008. Patients with diabetes and ESRD were selected as the study cohort. Propensity score adjustment and Cox-s proportional hazards regression model were used to estimate the hazard ratios HRs for new-onset MI.

Results

Among 15,161 patients, 39% received insulin, 40% received sulfonylureas, 18% received meglitinides and 3% received thiazolidinedione TZD. After a median follow-up of 1,357 days, the incidence of MI was significant increase in patients taking sulfonylureas HR = 1.523, 95% confidence interval CI = 1.331–1.744, meglitinides HR = 1.251, 95% CI = 1.048–1.494 and TZD HR = 1.515, 95% CI = 1.071–2.145 by using patients receiving insulin therapy as the reference group. The risk of MI remains higher in other three groups in subgroup analyses.

Conclusions

In conclusion, among diabetic patients with ESRD undergoing dialysis, the use of sulfonylureas, meglitinides and TZD are associated with higher risk of new-onset MI as compared with insulin.



Author: Ting-Tse Lin, Chih-Chen Wu, Yao-Hsu Yang, Lian-Yu Lin , Jiunn-Lee Lin, Pau-Chung Chen, Juey-Jen Hwang

Source: http://plos.srce.hr/



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