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Thallium-201 washout rate of stress myocardial perfusion imaging as a predictor of mortality in diabetic kidney disease patients initiating hemodialysis: an observational, follow-up study

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Abstract

Background

Thallium-201 washout rate of stress myocardial perfusion imaging (MPI) has been reported to correlate with coronary flow reserve which is a parameter of myocardial microcirculation. However, the evidence for its use in diabetic kidney disease (DKD) has been lacking, and the association between thallium-201 washout rate and adverse outcomes including death is unknown. Therefore, the present study was conducted to evaluate the predictive ability of thallium-201 washout rate for mortality in DKD patients initiating hemodialysis.

Methods

A total of 96 patients with type 2 diabetes who had been started on maintenance hemodialysis undergoing stress MPI with thallium-201 within 1 year, 72 men and 24 women, with a median age of 67 years, were studied. The endpoint was defined as all-cause death. The Cox proportional hazards model was used to calculate hazard ratios (HR) and 95% confidence intervals (CI).

Results

During the mean follow-up period of 3.4 ± 2.1 years, 18 (18.8%) deaths occurred. Cumulative survival rates during the follow-up period, with thallium-201 washout rate levels in the lowest tertile (3.1–36.2%), the middle tertile (36.5–46.3%), and the highest tertile (46.4–66.2%), were 51.0, 86.5, and 85.3%, respectively. Overall, the multivariate Cox regression analysis revealed that thallium-201 washout rate remained an independent predictor of death after adjusting by confounding variables (HR 0.91, 95% CI 0.85–0.97).

Conclusions

Among DKD patients initiating hemodialysis, thallium-201 washout rate seems to be useful for predicting death.

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Authors and Affiliations

  1. Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan

    Toshihide Hayashi, Nobuhiko Joki, Yuri Tanaka, Masaki Iwasaki, Shun Kubo, Ai Matsukane, Yasunori Takahashi & Hiroki Hase

  2. Division of Dialysis, Nissan Tamagawa Hospital, 4-8-1 Seta Setagaya-ku, Tokyo, 158-0095, Japan

    Yoshihiko Imamura

  3. Hirahata Clinic, 1-24-6 Shibuya, Shibuya-ku, Tokyo, 150-0002, Japan

    Koichi Hirahata

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  1. Toshihide Hayashi
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  2. Nobuhiko Joki
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Correspondence to Nobuhiko Joki.

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All authors have no conflicts of interest to declare in connection with this paper.

Ethical statement

This study adhered to the Declaration of Helsinki. The Ethics Committee for Clinical Research at Toho University Ohashi Medical Center approved the study protocol [Permission no. 13-52 and 13-61].

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All patients provided informed consent to participate in the study.

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Hayashi, T., Joki, N., Tanaka, Y. et al. Thallium-201 washout rate of stress myocardial perfusion imaging as a predictor of mortality in diabetic kidney disease patients initiating hemodialysis: an observational, follow-up study. Clin Exp Nephrol 22, 142–150 (2018). https://doi.org/10.1007/s10157-017-1414-9

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