A RETROSPECTIVE study suggests that patients undergoing long-term dialysis due to diabetic nephropathy face significantly higher in-hospital mortality following acute myocardial infarction (AMI) compared with other dialysis patients.
Researchers analysed 239 dialysis patients who underwent percutaneous coronary intervention (PCI) for AMI, dividing them into two groups: those with long-term dialysis (≥3 years) due to diabetic nephropathy (DMN) (n=101), and those with other dialysis backgrounds (n=138). The study aimed to clarify whether the underlying cause of kidney disease and duration of dialysis influence short-term cardiovascular outcomes.
Why Long-Term Dialysis May Worsen Outcomes
The findings revealed that patients in the long-term DMN group presented with more severe clinical features at admission. They were more likely to have advanced Killip class, experience prehospital cardiac arrest, and exhibit lower left ventricular ejection fraction. In addition, these patients had a higher prevalence of multivessel coronary disease and severe arterial calcification, indicating more extensive cardiovascular damage.
Crucially, the incidence of in-hospital death was significantly higher in the long-term DMN group (14.9%) compared to the other group (5.8%). Statistical analysis confirmed that long-term dialysis due to diabetic nephropathy was independently associated with increased in-hospital mortality (odds ratio 2.601), even after adjusting for age and sex.
The authors highlight that diabetic nephropathy may accelerate systemic vascular damage, compounding the already elevated cardiovascular risk seen in dialysis populations. The longer duration of dialysis could further contribute to cumulative cardiovascular burden, including vascular calcification and cardiac dysfunction.
Implications for Clinical Practice and Patient Care
These findings underscore the importance of recognising high-risk subgroups within dialysis populations. Patients with prolonged dialysis due to diabetic nephropathy may require more intensive monitoring, earlier intervention, and tailored management strategies when presenting with AMI.
While the study is limited by its retrospective design and single-cohort analysis, it adds to growing evidence that not all dialysis patients share equal cardiovascular risk. Future prospective studies are needed to confirm these findings and explore targeted interventions that could improve outcomes in this particularly vulnerable group.
Reference
Ishibashi S et al. The long-term dialysis due to diabetic nephropathy may be associated with in-hospital death in patients with acute myocardial infarction. Heart Vessels. 2026; DOI: 10.1007/s00380-026-02686-z
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