title: Time-dependent impact of diabetes on the mortality of patients on renal replacement therapy: a population-based study in Germany (2002-2009).
abstract: OBJECTIVE
  To estimate the impact of diabetes on the mortality of patients with incident renal replacement therapy (RRT).
  
  
  METHODS
  We assessed the mortality of 544 incident RRT patients aged ≥ 30 years between 2002 and 2009 (57.9% men, mean age 70.3 years, 49.6% patients with diabetes) by analyzing the data of all dialysis centers covering a German region. We compared the estimated time-dependent hazard ratios of patients with and without diabetes by using the Cox proportional-hazards regression model.
  
  
  RESULTS
  Overall, 319 patients had died (158 diabetic), approximately 50% after 3 years. Up to about 3 years, the mortality rate was lower in diabetic than in nondiabetic patients. Thereafter, the survival curves crossed (interaction diabetes × time, p = 0.002; adjusted hazard ratios for diabetes: baseline, 0.66; year 1, 0.84; year 2, 1.05; year 3, 1.33; year 4, 1.68). The results were similar in men and women; however, the interaction of diabetes and time was significant only in men (p = 0.004). Further significant risk factors of mortality were age, sex, initial central venous catheter, cardiovascular disease, and malignancy.
  
  
  CONCLUSIONS
  In this population-based study, the influence of diabetes was time-dependent, with a lower mortality in diabetic versus non-diabetic patients in the first three years but a higher mortality in these patients after 3 years. Results were similar in men and women.
authors.affiliation: Department of Public Health, Faculty of Medicine, Heinrich-Heine-University, Düsseldorf, Germany. andrea.icks@uni-duesseldorf.de
authors.forename: Andrea
authors.initials: A
authors.lastname: Icks
authors.forename: Burkhard
authors.initials: B
authors.lastname: Haastert
authors.forename: Jutta
authors.initials: J
authors.lastname: Genz
authors.forename: Guido
authors.initials: G
authors.lastname: Giani
authors.forename: Falk
authors.initials: F
authors.lastname: Hoffmann
authors.forename: Rudolf
authors.initials: R
authors.lastname: Trapp
authors.forename: Michael
authors.initials: M
authors.lastname: Koch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000401:mortality* / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017582:Renal Replacement Therapy / Q000401:mortality*; D013997:Time Factors