Predictors of Cardiovascular Events in Patients Undergoing Maintenance Hemodialysis for Diabetic Kidney Disease: A Two-year Prospective Cohort Study

Background/Aim: Patients undergoing maintenance hemodialysis (HD) for diabetic kidney disease (DKD) have a high risk of cardiovascular (CV) events. This study aimed to identify predictors of CV events in these patients, focusing on the prognostic significance of plasma docosapentaenoic acid (DPA). Patients and Methods: This prospective study enrolled 255 patients on maintenance HD between May 2019 and May 2020. Of these, 123 patients whose underlying disease was DKD were analyzed in this study. Baseline clinical parameters, lipid profiles, plasma fatty acids, and high-sensitivity C-reactive protein (hs-CRP) were measured. Patients were followed for two years to monitor CV events. Results: During follow-up, 28 CV events occurred. Kaplan-Meier analysis showed that a history of CV disease, high hs-CRP, and low plasma DPA levels were significantly associated with CV events. Multivariable Cox regression identified a history of CV disease [hazard ratio (HR)=4.86, p<0.001] and elevated hs-CRP (HR=2.80, p=0.035) as independent predictors of CV events. The association of lower DPA with CV events in univariate analysis was not retained after multivariable adjustment. Conclusion: A history of CV disease and elevated hs-CRP are independent predictors of future CV events in patients on maintenance HD for DKD. While lower DPA levels were associated with CV risk in univariate analysis, larger multicenter studies are needed to fully clarify its prognostic significance.