Renal failure is a major independent predictor of cardiovascular events. Diabetes is the leading cause of renal failure in Western countries. In 2002 in the United States, diabetic nephropathy accounted for more than 40% of the new cases of renal failure, and 44,000 diabetic patients began treatment for endstage renal disease.2 The condition underlying diabetic nephropathy is microvascular disease. Even in the absence of renal failure, albuminuria is a frequent finding in diabetes. Any degree of albuminuria has been found to be a risk factor for CV events, regardless of the presence or absence of diabetes.137 In addition, diabetic nephropathy with or without renal failure is a key determinant of risk after both PCI and CABG. A single-center analysis involving 1575 diabetic patients undergoing PCI showed that patients with renal failure had significantly more in-hospital complications than those with normal renal function, including mortality (2.6% versus 0.5%, respectively), neurologic events (3.1% versus 0.6%), and gastrointestinal bleeding (2.9% versus 0.9%).138 The 1-year mortality rate was strikingly higher in patients with chronic renal insufficiency (16%) than in those with preserved renal function (5%). Similarly, an analysis reviewing more than 480,000 patients undergoing CABG demonstrated that, compared with patients with normal renal function, the adjusted OR for mortality was 1.7 among patients with moderate renal dysfunction, 3.2 among those with severe dysfunction, and 3.6 among patients undergoing dialysis.139
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