Hemodialysis in patients older than 65 years with end-stage renal failure--comparison of outcome in patients with and without diabetes.
BACKGROUND
During recent years, the number of patients with end-stage renal disease (ESRD) has been rising worldwide. Especially older patients and those with diabetes contribute to this rise. The aim of the present study was to evaluate whether patients older than 65 years with type 2 diabetes, who started first dialysis, have a higher prevalence of vascular diseases and co-morbidities, show a higher incidence of vascular complications and/or have a higher mortality rate than elderly non-diabetic patients with ESRD.


METHODS
In this study, 82 consecutive patients with ESRD, who had either type 2 diabetes or did not have diabetes and who had started chronic hemodialysis (HD) in our dialysis center during the years 1994 to 2002, were included. Patients were included when they were older than 65 years. Patients were divided into two groups: those with diabetes (DM) (n = 47) and those without diabetes (nDM) (n = 35). For both groups the number of co-morbidities as well as the prevalence of vascular diseases and vascular risk-factors at the start of HD was evaluated. In addition, the incidence of vascular complications was registered over a 3-year observation period. In both groups serum(S)-creatinine, blood urea nitrogen (BUN), creatinine clearance, hemoglobin, fasting blood glucose, HbA1c (in diabetic patients), cholesterol, triglycerides and phosphorus were evaluated.


RESULTS
At the start of HD the creatinine clearance was significantly higher in diabetic subjects (nDM 7.1 +/- 2.1 vs DM 9.5 +/- 4.4 ml/min/1.73 m2; p < 0.005). For S-creatinine the difference was not statistically significant (nDM 8.7 +/- 3.3 mg/dl vs DM 7.4 +/- 2.4; p = 0.07). Fasting blood glucose was significantly higher in diabetic patients (p < 0.001). BUN, hemoglobin, phosphorus and lipids were not significantly different in both groups. There was no statistically significant difference in systolic or diastolic blood pressure, but a higher amount of antihypertensive drugs were necessary in the DM group for blood pressure control (p < 0.01). In both groups there was a high prevalence of vascular diseases at the start of HD. In the diabetic patients the prevalence of peripheral vascular disease was significantly higher. Furthermore, in the first and second year significantly more vascular complications were observed in the DM group (p < 0.01). Survival was low in both groups. The 3-year survival was 20.0% in non-diabetic and 17.0% in diabetic patients (NS).


CONCLUSIONS
Patients older than 65 years with ESRD have a low survival with and without type 2 diabetes. The mortality rate was only slightly higher in the diabetic group and was not statistically significant. The prevalence of vascular diseases and co-morbidities is high in both groups; however, the incidence of cardiovascular complications was significantly higher in our diabetic patients.
Pieringer
Herwig
H
2nd Department of Medicine, General Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria. Interne2@akh.linz.at
Biesenbach
Georg
G
D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000401:mortality / Q000628:therapy; D001317:Austria; D002318:Cardiovascular Diseases / Q000401:mortality / Q000628:therapy; D002423:Cause of Death; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D007677:Kidney Function Tests; D008297:Male; D017063:Outcome Assessment, Health Care; D006435:Renal Dialysis; D012307:Risk Factors