Prognostic factors in Brazilian diabetic patients starting dialysis: a 3.6-year follow-up study.
The objective of this study was to analyze the prognostic factors of a cohort of diabetic patients starting dialysis. This prospective, 3. 6-year population-based cohort study included 111 diabetic patients starting dialysis in all 18 dialysis centers of the metropolitan area of Porto Alegre, Brazil, between July 1995 and October 1996. The survival rate was analyzed by Kaplan-Meier curves and prognostic factors for death by Cox's proportional-hazards model. During the study period, 685 patients started dialysis; 182 (26.5%) had diabetes and 111 patients were included. Eighty-four percent of the 111 patients were classified as type 2 diabetes (random C-peptide>0. 6 ng/ml), and these patients presented more coronary artery disease (60% vs. 29%; P<0.02) than type 1 patients. In type 2 patients, later diagnosis of diabetes was associated with a shorter interval until beginning of dialysis (r=0.67; P=0.001). Diabetic nephropathy was the primary renal disease in 61% of all patients. Overall median survival (26 months) was similar for types 1 and 2 diabetic patients. Survival in the first, second, and third year was 69%, 51%, and 28%, respectively. Cardiovascular disease was the most common cause (63%) of death. According to Cox's proportional-hazards model, history of stroke (HR: 4.53, CI: 2.09-9.86, P<0.0001), amputations (HR: 3.2, CI: 1.61-6.35, P<0.0009), and coronary artery disease (HR: 1.67, CI: 0.95-2.96, P<0.076) at baseline were significantly associated with mortality. In conclusion, macrovascular complications were the main predictors of mortality in this cohort of diabetic patients starting dialysis. Intensive treatment of cardiovascular risk factors during dialysis might reduce the mortality rate of diabetic patients.
Bruno
R M
RM
Renal Division, Complexo Hospitalar Santa Casa de Porto Alegre, and Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, RS, Porto Alegre, Brazil.
Gross
J L
JL
D000328:Adult; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001938:Brazil; D002423:Cause of Death; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000401:mortality / Q000628:therapy*; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality; D015996:Survival Rate; D013997:Time Factors; D014505:Urban Population