Perceived health-related quality of life and comorbidity in diabetic patients starting dialysis (CALVIDIA study).
BACKGROUND
Diabetes mellitus (DM) is a widespread prevalent illness, currently the main cause of end-stage renal disease (ESRD).


METHODS
In a longitudinal, prospective study we compared two cohorts of patients starting dialysis therapy, diabetic and non-diabetic ESRD patients. Perceived health was measured by the Medical Outcomes Study Short-Form 36 (SF-36) questionnaire, functional status by the Karnofsky scale and comorbidity by the Charlson age-comorbidity index. A broad spectrum of variables in relation to diabetes, ESRD, comorbidity and renal replacement therapy (RRT) were studied, as well as the distribution of comorbidity frequencies at dialysis start.


RESULTS
Thirty-four Spanish centers included 232 diabetic patients, 43 type 1 and 189 type 2, mean diabetes duration 18 +/- 9 yrs, and five centers included 121 non-diabetic patients. Out of the 232 diabetic patients, 187 patients (81%) started hemodialysis (HD) and 45 patients (19%) started peritoneal dialysis (PD) (vs. 82% and 18%, respectively in non-diabetic patients). Transient vascular access (VA) for starting RRT was required in 54% of the diabetic patients vs. 53% in the nondiabetic patients. When both study groups were compared, diabetic patients required antihypertensive drugs more frequently than non-diabetic patients and showed higher systolic blood pressure (BP), as well as higher cardiovascular (CV) complication incidences, poorer SF-36 physical component summary scores and mental component summary scores and worse Karnofsky scale scores, with the Charlson age-comorbidity score being higher.


CONCLUSIONS
Diabetic patients starting dialysis in Spain are more often type 2 diabetics, have worse perceived health-related quality of life (HRQoL) in relation to non-diabetic patients, worse functional status and higher incidences of prognostic mortality markers.
Martínez-Castelao
Alberto
A
Department of Nephrology, Bellvitge Hospital, University of Barcelona, Barcelona, Spain. amcastel@terra.es
Gòrriz
José Luis
JL
Garcia-López
Fernando
F
López-Revuelta
Katia
K
De Alvaro
Fernando
F
Cruzado
Josep M
JM
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D007677:Kidney Function Tests; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D006435:Renal Dialysis / Q000379:methods*; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D018434:Sickness Impact Profile; D016896:Treatment Outcome