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Diabetologia

, Volume 56, Issue 9, pp 1949–1957 | Cite as

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

  • M. A. SchroijenEmail author
  • M. W. M. van de Luijtgaarden
  • M. Noordzij
  • P. Ravani
  • F. Jarraya
  • F. Collart
  • K. G. Prütz
  • D. G. Fogarty
  • T. Leivestad
  • F. C. Prischl
  • C. Wanner
  • F. W. Dekker
  • K. J. Jager
  • O. M. Dekkers
Article

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.

Keywords

Diabetes as co-morbid condition Diabetes as primary renal disease Diabetes mellitus Diabetic nephropathy Dialysis Survival 

Abbreviations

ERA-EDTA

European Renal Association-European Dialysis and Transplant Association

ESRD

End-stage renal disease

HD

Haemodialysis

NECOSAD

Netherlands Cooperative Study on the Adequacy of Dialysis

PD

Peritoneal dialysis

RRT

Renal replacement therapy

Notes

Acknowledgements

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.

Contribution statement

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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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • M. A. Schroijen
    • 1
    • 2
    Email author
  • M. W. M. van de Luijtgaarden
    • 3
  • M. Noordzij
    • 3
  • P. Ravani
    • 4
  • F. Jarraya
    • 5
  • F. Collart
    • 6
  • K. G. Prütz
    • 7
  • D. G. Fogarty
    • 8
  • T. Leivestad
    • 9
  • F. C. Prischl
    • 10
  • C. Wanner
    • 11
  • F. W. Dekker
    • 1
  • K. J. Jager
    • 3
  • O. M. Dekkers
    • 1
    • 2
  1. 1.Department of Clinical EpidemiologyC7, Leiden University Medical CenterLeidenthe Netherlands
  2. 2.Department of Endocrinology and Metabolic DiseasesLeiden University Medical CenterLeidenthe Netherlands
  3. 3.ERA-EDTA Registry, Department of Medical InformaticsAcademic Medical Center AmsterdamAmsterdamthe Netherlands
  4. 4.Division of Nephrology, Departments of Medicine and Community Health SciencesUniversity of CalgaryCalgaryCanada
  5. 5.Department of NephrologyHédi Chaker HospitalSfaxTunisia
  6. 6.French-Speaking Belgium ESRD RegistryBruxellesBelgium
  7. 7.Swedish Renal RegistryJönköpingSweden
  8. 8.Nephrology Research Group, Centre for Public Health, Queen’s University and Regional Nephrology UnitBelfast City HospitalBelfastUK
  9. 9.Norwegian Renal Registry, Renal Unit, Department of Transplantation MedicineOslo University HospitalOsloNorway
  10. 10.Department of Nephrology, 4th Internal DepartmentKlinikum Wels-GrieskirchenWelsAustria
  11. 11.Department of Medicine I, Division of NephrologyUniversity of WürzburgWürzburgGermany

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