title: Survival in dialysis patients is different between patients with diabetes as primary renal disease and patients with diabetes as a co-morbid condition.
abstract: OBJECTIVE
  A previous study in Dutch dialysis patients showed no survival difference between patients with diabetes as primary renal disease and those with diabetes as a co-morbid condition. As this was not in line with our hypothesis, we aimed to verify these results in a larger international cohort of dialysis patients.
  
  
  METHODS
  For the present prospective study, we used data from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry. Incident dialysis patients with data on co-morbidities (n = 15,419) were monitored until kidney transplantation, death or end of the study period (5 years). Cox regression was performed to compare survival for patients with diabetes as primary renal disease, patients with diabetes as a co-morbid condition and non-diabetic patients.
  
  
  RESULTS
  Of the study population, 3,624 patients (24%) had diabetes as primary renal disease and 1,193 (11%) had diabetes as a co-morbid condition whereas the majority had no diabetes (n = 10,602). During follow-up, 7,584 (49%) patients died. In both groups of diabetic patients mortality was higher compared with the non-diabetic patients. Mortality was higher in patients with diabetes as primary renal disease than in patients with diabetes as a co-morbid condition, adjusted for age, sex, country and malignancy (HR 1.20, 95% CI 1.10, 1.30). An analysis stratified by dialysis modality yielded similar results.
  
  
  CONCLUSIONS
  Overall mortality was significantly higher in patients with diabetes as primary renal disease compared with those with diabetes as a co-morbid condition. This suggests that survival in diabetic dialysis patients is affected by the extent to which diabetes has induced organ damage.
authors.affiliation: Department of Clinical Epidemiology, C7 Leiden University Medical Center, Albinusdreef 2, 2333 Leiden, the Netherlands. M.A.Schroijen@lumc.nl
authors.forename: M A
authors.initials: MA
authors.lastname: Schroijen
authors.forename: M W M
authors.initials: MW
authors.lastname: van de Luijtgaarden
authors.forename: M
authors.initials: M
authors.lastname: Noordzij
authors.forename: P
authors.initials: P
authors.lastname: Ravani
authors.forename: F
authors.initials: F
authors.lastname: Jarraya
authors.forename: F
authors.initials: F
authors.lastname: Collart
authors.forename: K G
authors.initials: KG
authors.lastname: Prütz
authors.forename: D G
authors.initials: DG
authors.lastname: Fogarty
authors.forename: T
authors.initials: T
authors.lastname: Leivestad
authors.forename: F C
authors.initials: FC
authors.lastname: Prischl
authors.forename: C
authors.initials: C
authors.lastname: Wanner
authors.forename: F W
authors.initials: FW
authors.lastname: Dekker
authors.forename: K J
authors.initials: KJ
authors.lastname: Jager
authors.forename: O M
authors.initials: OM
authors.lastname: Dekkers
mesh_terms: D000368:Aged; D003920:Diabetes Mellitus / Q000401:mortality*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000706:statistics & numerical data*