Katharina M. Espe, Jens Raila, Andrea Henze, Katja Blouin, Andreas Schneider, Daniel Schmiedeke, Vera Krane, Stefan Pilz, Florian J. Schweigert, Berthold Hocher, Christoph Wanner, Christiane Drechsler
- Background and objectives Trials with the antioxidant vitamin E have failed to show benefit in the general population. Considering the different causes of death in ESRD, this study investigated the association between plasma concentrations of alpha-tocopherol and specific clinical outcomes in diabetic hemodialysis patients.
Design, settings, participants, & measurements In 1046 diabetic hemodialysis patients (participants of the German Diabetes and Dialysis Study), alpha-tocopherol was measured in plasma by reversed-phase HPLC. By Cox regression analyses, hazard ratios were determined for prespecified end points according to baseline plasma alpha-tocopherol levels: sudden death (n=134), myocardial infarction (n=172), stroke (n=89), combined cardiovascular events (n=398), fatal infection (n=107), and all-cause mortality (n=508).
Results Patients had a mean age of 66 8 years, and mean plasma alpha-tocopherol level was 22.8+/-9.6 mu mol/L. Levels of alpha-tocopherol were highly correlated to triglycerides (r=0.63, P<0.001). Patients inBackground and objectives Trials with the antioxidant vitamin E have failed to show benefit in the general population. Considering the different causes of death in ESRD, this study investigated the association between plasma concentrations of alpha-tocopherol and specific clinical outcomes in diabetic hemodialysis patients.
Design, settings, participants, & measurements In 1046 diabetic hemodialysis patients (participants of the German Diabetes and Dialysis Study), alpha-tocopherol was measured in plasma by reversed-phase HPLC. By Cox regression analyses, hazard ratios were determined for prespecified end points according to baseline plasma alpha-tocopherol levels: sudden death (n=134), myocardial infarction (n=172), stroke (n=89), combined cardiovascular events (n=398), fatal infection (n=107), and all-cause mortality (n=508).
Results Patients had a mean age of 66 8 years, and mean plasma alpha-tocopherol level was 22.8+/-9.6 mu mol/L. Levels of alpha-tocopherol were highly correlated to triglycerides (r=0.63, P<0.001). Patients in the lowest alpha-tocopherol quartile had (in unadjusted analyses) a 79% higher risk of stroke and a 31% higher risk of all-cause mortality compared with patients in the highest quartile. The associations were attenuated after adjustment for confounders (hazard ratio(stroke)=1.56, 95% confidence interval=0.75-3.25; hazard ratio(mortality)=1.22, 95% confidence interval=0.89-1.69, respectively). There was no association between alpha-tocopherol and myocardial infarction, sudden death, or infectious death.
Conclusions Plasma alpha-tocopherol concentrations were not independently associated with cardiovascular outcomes, infectious deaths, or all-cause mortality in diabetic hemodialysis patients. The lack of association can partly be explained by a confounding influence of malnutrition, which should be considered in the planning of trials to reduce cardiovascular risk in dialysis patients.…
MetadatenAuthor details: | Katharina M. Espe, Jens RailaORCiDGND, Andrea HenzeORCiDGND, Katja Blouin, Andreas Schneider, Daniel Schmiedeke, Vera Krane, Stefan Pilz, Florian J. SchweigertORCiDGND, Berthold HocherORCiDGND, Christoph Wanner, Christiane Drechsler |
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DOI: | https://doi.org/10.2215/CJN.04880511 |
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ISSN: | 1555-9041 |
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Title of parent work (English): | Clinical journal of the American Society of Nephrology |
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Publisher: | American Society of Nephrology |
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Place of publishing: | Washington |
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Publication type: | Article |
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Language: | English |
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Year of first publication: | 2013 |
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Publication year: | 2013 |
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Creating corporation: | German Diabet & Dialysis Study Inv |
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Release date: | 2017/03/26 |
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Volume: | 8 |
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Issue: | 3 |
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Number of pages: | 7 |
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First page: | 452 |
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Last Page: | 458 |
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Funding institution: | Else-Kroner-Fresenius Foundation; Interdisziplinares Zentrum fur
Klinische Forschung of the University of Wurzburg; Medical Faculty of
the University of Wurzburg |
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Organizational units: | Mathematisch-Naturwissenschaftliche Fakultät / Institut für Ernährungswissenschaft |
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Peer review: | Referiert |
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