Survival in dialysis patients is different between patients with diabetes as primary renal disease and patients with diabetes as a co-morbid condition
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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.
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.
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.
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.
KeywordsDiabetes as co-morbid condition Diabetes as primary renal disease Diabetes mellitus Diabetic nephropathy Dialysis Survival
European Renal Association-European Dialysis and Transplant Association
End-stage renal disease
Netherlands Cooperative Study on the Adequacy of Dialysis
Renal replacement therapy
The ERA-EDTA Registry is funded by the ERA-EDTA. We would like to thank the patients and staff of all the dialysis units who contributed data via their national and regional renal registries. In addition, we would like to thank the following persons for their contribution to the work of the ERA-EDTA Registry: R. Kramar (Austrian Dialysis and Transplant Registry), J. Comas (Catalan Renal Registry) and G. A. Ioannidis (Hellenic Renal Registry) for providing the data for this study; ERA-EDTA Registry committee members (R. Vanholder, Belgium [ERA-EDTA president], C. Wanner (Germany, [Registry chairman]), D. Ansell (UK), C. Combe (France), L. Garneata (Romania) F. Jarraya (Tunisia), P. Ravani (Italy), R. Saracho (Spain), F. Schaefer (Germany), S. Schön (Sweden) and E. Verrina (Italy).
Duality of interest
The authors declare that there is no duality of interest associated with this manuscript.
MAS, MWML, MN, FWD, KJJ and OMD were involved in design of the study, analysis and interpretation of the data, drafting the manuscript and revision of the manuscript based on comments from co-authors. PR, FJ, FC, KGP, DGF, TL, FCP and CW were involved in the design of the study, data collection, interpretation of the data and revision of the manuscript. All authors approved the final version of the manuscript.
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