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Articles by E Ritz
Total Records ( 2 ) for E Ritz
  C Drechsler , V Krane , E Ritz , W Marz and C. Wanner

Background— Patients on maintenance dialysis treatment experience an excess mortality, predominantly of sudden cardiac death. Poor glycemic control is associated with cardiovascular comorbidities in the general population. This study investigated the impact of glycemic control on cardiac and vascular outcomes in diabetic hemodialysis patients.

Methods and Results— Glycohemoglobin A1c (HbA1c) was measured in 1255 hemodialysis patients with type 2 diabetes mellitus who participated in the German Diabetes and Dialysis Study (4D Study) and were followed up for a median of 4 years. Using Cox regression analyses, we determined hazard ratios to reach prespecified, adjudicated end points according to HbA1c levels at baseline: sudden cardiac death (n=160), myocardial infarction (n=200), stroke (n=103), cardiovascular events (n=469), death caused by heart failure (n=41), and all-cause mortality (n=617). Patients had a mean age of 66±8 years (54% male) and mean HbA1c of 6.7±1.3%. Patients with an HbA1c >8% had a >2-fold higher risk of sudden death compared with those with an HbA1c ≤6% (hazard ratio, 2.14; 95% confidence interval, 1.33 to 3.44), persisting in multivariate models. With each 1% increase in HbA1c, the risk of sudden death rose significantly by 18%; similarly, cardiovascular events and mortality increased by 8%. There was a trend for higher risks of stroke and deaths resulting from heart failure, whereas myocardial infarction was not affected. The increased risks of both cardiovascular events and mortality were explained mainly by the impact of HbA1c on sudden death.

Conclusions— Poor glycemic control was strongly associated with sudden cardiac death in diabetic hemodialysis patients, which accounted for increased cardiovascular events and mortality. In contrast, myocardial infarction was not affected. Whether interventions achieving tight glycemic control decrease sudden death requires further evaluation.

Clinical Trial Registration— URL: Unique identifier: CT-981–423–239.

  K. S Spanaus , B Kollerits , E Ritz , M Hersberger , F Kronenberg , A von Eckardstein and for the Mild and Moderate Kidney Disease (MMKD) Study Group

Background: Impaired baseline kidney function is a well-defined risk factor for progression of chronic kidney disease (CKD). We evaluated measured glomerular filtration rate (GFR) and the serum markers creatinine, cystatin C, and β-trace protein (BTP) for diagnostic accuracy in defining the stage of kidney impairment and as risk predictors of CKD progression.

Methods: We measured serum marker concentrations in 227 patients with primary nondiabetic CKD and various degrees of renal impairment and followed 177 patients prospectively for up to 7 years to assess progression of CKD.

Results: At baseline, creatinine, cystatin C, and BTP were strongly correlated with GFR as measured by iohexol clearance. Concentrations of all 3 markers increased progressively with decreasing GFR, and their diagnostic performance for the detection of even minor deteriorations of renal function (GFR <90 mL · min–1 · (1.73 m2)–1) was similar. Sixty-five patients experienced progression of CKD, defined as doubling of baseline creatinine and/or terminal renal failure during prospective follow-up. These patients were older and had a lower GFR and higher serum creatinine, cystatin C, and BTP values at baseline (all P < 0.001) compared with the patients who did not reach a predefined renal endpoint. Cox proportional hazard regression analysis revealed that all 3 clearance markers were equally strong predictors of CKD progression, even after adjustment for age, sex, GFR, and proteinuria.

Conclusions: The diagnostic performance of serum creatinine, cystatin C, or BTP for detecting even minor degrees of deterioration of renal function is good, and these markers provide reliable risk prediction for progression of kidney disease in patients with CKD.

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