Association of heart disease with diabetes and hypertension in patients with ESRD

Background: No published study has reported the combined effect of diabetes and hypertension on heart disease in patients with renal failure. We determined this effect by using data for all US adults who started renal replacement therapy from 1995 to 1999. Methods: Data for patient characteristics, diabetes, hypertension, and heart disease were collected from the Medical Evidence Report, on which 6 cardiac conditions were recorded: congestive heart failure, ischemic heart disease, myocardial infarction, cardiac arrest, cardiac arrhythmia, and pericarditis. On the basis of diabetic-hypertensive status, we categorized patients into 4 groups: diabetes only, hypertension only, both diabetes and hypertension, and neither diabetes nor hypertension. Adjusting for age, sex, race-ethnicity, and incidence year with logistic regression, we estimated the likelihood of heart disease according to diabetic-hypertensive status. Results: Of 373,539 patients, 49.8% had diabetes and 75.8% had hypertension; 11.4% had diabetes only, 37.4% had hypertension only, 38.4% had both diabetes and hypertension, and 12.8% had neither diabetes nor hypertension. Approximately 44% of patients (n = 163,570) had at least 1 condition, 19.4% had at least 2 conditions, and 6.5% had at least 3 of the 6 cardiac conditions. Logistic regression indicated that patients with diabetes only and hypertension only were 3.1 and 2.8 times more likely (P < 0.0001) to have heart disease than those without diabetes and hypertension, respectively. Patients with both diabetes and hypertension were 5.9, 5.0, and 4.8 times more likely (P < 0.0001) to have at least 1, at least 2, and at least 3 cardiac conditions than those with neither diabetes nor hypertension, respectively. Conclusion: Patients with renal failure with both diabetes and hypertension are more likely to have heart disease than those with diabetes only and hypertension only.