Survival in dialysis patients is different between patients with diabetes as primary renal disease and patients with diabetes as a co-morbid condition.

MA Schroijen, MW van de Luijtgaarden , M Noordzij, P Ravani , F Jarraya , F Collart, KG Prutz, Damian Fogarty, T Leivestad, FC Prischl, C Wanner, FW Dekker, KJ Jager, OM Dekkers

Research output: Contribution to journalArticlepeer-review

22 Citations (Scopus)

Abstract

AIMS/HYPOTHESIS:

A previous study in Dutch dialysis patients showed no survival difference between patients with diabetes as primary renal disease and those with diabetes as a co-morbid condition. As this was not in line with our hypothesis, we aimed to verify these results in a larger international cohort of dialysis patients.

METHODS:

For the present prospective study, we used data from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry. Incident dialysis patients with data on co-morbidities (n?=?15,419) were monitored until kidney transplantation, death or end of the study period (5 years). Cox regression was performed to compare survival for patients with diabetes as primary renal disease, patients with diabetes as a co-morbid condition and non-diabetic patients.

RESULTS:

Of the study population, 3,624 patients (24%) had diabetes as primary renal disease and 1,193 (11%) had diabetes as a co-morbid condition whereas the majority had no diabetes (n?=?10,602). During follow-up, 7,584 (49%) patients died. In both groups of diabetic patients mortality was higher compared with the non-diabetic patients. Mortality was higher in patients with diabetes as primary renal disease than in patients with diabetes as a co-morbid condition, adjusted for age, sex, country and malignancy (HR 1.20, 95% CI 1.10, 1.30). An analysis stratified by dialysis modality yielded similar results.

CONCLUSIONS/INTERPRETATION:

Overall mortality was significantly higher in patients with diabetes as primary renal disease compared with those with diabetes as a co-morbid condition. This suggests that survival in diabetic dialysis patients is affected by the extent to which diabetes has induced organ damage.
Original languageEnglish
Pages (from-to)1949-1957
Number of pages8
JournalDiabetologia
Volume56
Issue number9
Early online date15 Jun 2013
DOIs
Publication statusPublished - 01 Sep 2013

Bibliographical note

Diabetes is the commonest cause of end-stage renal failure accounting for 20-50% of new patients in almost all renal units across the world. Previous studies have shown that in patients with diabetes and advanced CKD there are other defined causes of morbidity and death than classical diabetic nephropathy. It had traditionally been thought that these patients would have a similar prognosis meaning the underlying cause was irrelevant once on dialysis. This study shows this is wrong and indeed those with other causes of renal failure (not diabetic nephropathy/diabetic kidney disease) have significantly better survival than those with classic diabetic nephropathy. This is the first large multi-country paper to show this.

Keywords

  • diabetes
  • ckd
  • diaysis
  • comorbidity
  • transplant
  • renal replacement therapy

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

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