Value of diabetes as an independent predictor of death in subjects with end-stage renal disease.
OBJECTIVE
Diabetic subjects on hemodialysis have a poor survival. The authors performed a Kaplan-Meier survival analysis of diabetic versus nondiabetic subjects and investigated the value of diabetes as an independent predictor of death in these end-stage renal disease (ESRD) subjects.


METHODS
From 1997 to 2003, 135 ESRD subjects (41 diabetics) were enrolled in a survival study beginning at the start of dialysis. Inclusion criterion was onset of dialysis at least 6 months before study entry. Exclusion criteria comprised age < 45 years, coronary artery disease (CAD), critical limb ischemia (CLI), or malignancies at ESRD onset up to 6 months after study entry. Subjects with clinical signs of vascular disease were followed up by coronary or peripheral angiographies.


RESULTS
Baseline risk factors were similar between diabetic and nondiabetic subjects. The 5-year survival rate in nondiabetic subjects was 76.9% (95% confidence interval [CI] = 62-86%) versus 76.4% (95% CI = 53-89%) in diabetic patients (p = 0.402). Consistent with this finding, the Cox proportional hazards model revealed that diabetes does not significantly change the risk of death in ESRD subjects. De novo CAD developed in 35 and CLI in ten subjects, but both diseases were present more frequently in nonsurvivors (42% vs. 23%; p = 0.052) versus survivors (21% vs. 5%; p = 0.005).


CONCLUSIONS
Diabetes is not an independent predictor of death in the ESRD study group presented here. Prevention of CAD and CLI in diabetic subjects is most important to improve survival.
Koch
Michael
M
Center of Nephrology, Mettmann, Germany. koch@dialyse-mettmann.de
Hollenbeck
Markus
M
Trapp
Rudolf
R
Kulas
Wolfgang
W
Grabensee
Bernd
B
D000368:Aged; D000792:Angiography; D002423:Cause of Death; D016001:Confidence Intervals; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000517:prevention & control; D003627:Data Interpretation, Statistical; D003928:Diabetic Nephropathies / Q000401:mortality* / Q000628:therapy; D004562:Electrocardiography; D005121:Extremities / Q000098:blood supply; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors