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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.

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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Hayashi T, Joki N, Tanaka Y, Iwasaki M, Kubo S, Matsukane A, Takahashi Y, Imamura Y, Hirahata K, Hase H,


Hayashi T, Joki N, Tanaka Y, Iwasaki M, Kubo S, Matsukane A, Takahashi Y, Imamura Y, Hirahata K, Hase H, (click to view)

Hayashi T, Joki N, Tanaka Y, Iwasaki M, Kubo S, Matsukane A, Takahashi Y, Imamura Y, Hirahata K, Hase H,

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Clinical and experimental nephrology 2017 04 21() doi 10.1007/s10157-017-1414-9
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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