title: Patients with diabetes as the primary kidney disease have a worse survival than patients with comorbid diabetes in chronic haemodialysis patients.
abstract: OBJECTIVE
  Diabetes is the leading cause of chronic kidney disease (CKD) that requires dialysis. It is not clear if survival of patients with diabetes as primary kidney disease (DKD) is different from the survival of patients with diabetes as comorbidity (DCM). We investigated the survival of patients with DKD and patients with DCM in patients on maintenance haemodialysis (HD) using propensity score matching approach.
  
  
  METHODS
  All patients on maintenance HD in Taiwan Renal Registry Database from 1997 to 2005 were analyzed and were prospectively followed to 31 December 2008. Patients' survival was determined using Cox proportional-hazards regression.
  
  
  RESULTS
  We analyzed the survival of 2632 patients with DCM and 13,160 matched patients with DKD. The first year mortality rate was 11.9% in patients with DCM and 13.9% in patients with DKD. The incidence density rate of overall mortality was 11.2 per 100 patient-years in patients with DCM and 12.9 in patients with DKD. Patients with DKD had a worse survival than patients with DCM (P < 0.01). Compared to patients with DCM, the odds ratio (95% confidence interval [CI]) for first year mortality was 1.27 (1.10-1.47) and the hazard ratio for overall mortality was 1.18 (1.12-1.25) in patients with DKD. Patients' age, male gender, comorbid liver cirrhosis, higher fasting blood glucose, lower haematocrit, and lower serum phosphorus were independently associated with higher mortality.
  
  
  CONCLUSIONS
  Patients with diabetes as primary kidney disease are associated with higher first year and overall mortality, compared to patients with diabetes as comorbidity in patients on maintenance haemodialysis.
authors.affiliation: Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Hung-Chih
authors.initials: HC
authors.lastname: Chen
authors.forename: Che-Yi
authors.initials: CY
authors.lastname: Chou
authors.forename: Yi-Tzone
authors.initials: YT
authors.lastname: Hsiao
authors.forename: Chih-Chia
authors.initials: CC
authors.lastname: Liang
authors.forename: Huey-Liang
authors.initials: HL
authors.lastname: Kuo
authors.forename: Chiz-Tzung
authors.initials: CT
authors.lastname: Chang
authors.forename: Jiung-Hsiun
authors.initials: JH
authors.lastname: Liu
authors.forename: I-Kuan
authors.initials: IK
authors.lastname: Wang
authors.forename: Chiu-Ching
authors.initials: CC
authors.lastname: Huang
mesh_terms: D000368:Aged; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000401:mortality*; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
keywords: comorbidity; diabetic kidney disease; fasting blood glucose; haemodialysis; mortality