The Impact of type 2 diabetes on mortality in end-stage renal disease patients differs between genders.
OBJECTIVE
In diabetics with end-stage renal disease (ESRD), risk of death has been reported to be non-constant after the first dialysis, and different outcomes have been observed between genders. We assessed the impact of type 2 diabetes (T2DM) on mortality in dialysis regarding its differential effect by gender using time-dependent analyses.


METHODS
All T2DM and non-diabetic (no-DM) patients who started dialysis in two renal units in Lyon, France, between January 1, 1995, and December 31, 2007, were included. In multivariate analyses, the Cox model and Shoenfeld residual approach were used to assess the effect of T2DM on dialysis mortality by gender.


RESULTS
We included 235 T2DM (males: 57.9%) and 480 no-DM (males: 65.6%) patients. In males, the adjusted hazard ratio (aHR) for death in T2DM versus no-DM was 0.83 (p = 0.20) and was constant over time after the first renal replacement therapy (RRT) (p = 0.88). In females, aHR for death in T2DM versus no-DM patients was not constant over time (p = 0.002). It was 0.64 (p = 0.13) within the first year after the first RRT and 2.10 (p = 0.002) after the first year. Evolutions with time of these aHR by gender were significantly different (p = 0.009).


CONCLUSIONS
T2DM was associated with death only in females. This association was not constant over time after the first dialysis.
Karamé
A
A
Nephrology and Renal Transplantation, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France.
Labeeuw
M
M
Trolliet
P
P
Caillette-Beaudoin
A
A
Cahen
R
R
Ecochard
R
R
Galland
R
R
Hallonet
P
P
Pouteil-Noble
C
C
Villar
E
E
D000368:Aged; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality* / Q000534:rehabilitation*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000401:mortality*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D017678:Sex Distribution; D016019:Survival Analysis; D015996:Survival Rate