title: Diabetic kidney disease patients on hemodialysis: a retrospective survival analysis across different socioeconomic groups.
abstract: BACKGROUND
  Diabetic kidney disease is the leading cause of stage 5 chronic kidney disease (CKD) in India. Renal replacement therapy (RRT) is accessible to very few patients because of socioeconomic deprivation. We studied the effect of diabetes and socioeconomic status on the outcome of patients on maintenance hemodialysis (MHD).
  
  
  METHODS
  We retrospectively analyzed the outcome of 897 patients (629 males/268 females; mean age ± standard deviation 48.69 ± 14.27 years) initiated on MHD from 2003 to 2009 at five dialysis centers in south India. There were 335 type 2 diabetic patients and 562 non-diabetic patients. Group 1 comprised the self-paying patients (518 patients) and Group 2 included the TANKER Foundation charity dialysis patients (379 patients). We compared the 5-year survival rates of Group 1 versus Group 2 and also those of diabetic versus non-diabetic patients, using the Kaplan-Meier survival estimator.
  
  
  RESULTS
  Of the 897 patients, 166 patients survived, 350 died, 234 were lost to follow-up, 137 had renal transplantation and 10 patients were transferred to peritoneal dialysis. The 5-year survival rates after censoring were 20.7 and 38.2% for diabetic and non-diabetic patients, respectively (P < 0.001). The survival rate of diabetic patients was significantly lower, compared with non-diabetic patients, in Group 2 (P < 0.001), but not significantly lower in Group 1 (P = 0.226).
  
  
  CONCLUSIONS
  Diabetic patients have poor survival rates on MHD, especially those from poor socioeconomic groups. Due to scarce RRT facilities and poor survival rates of diabetic patients, prevention, early detection and management of diabetic CKD patients should be the way to go forward.
authors.affiliation: Kilpauk Medical College, Chennai, India.
authors.forename: Madhusudan
authors.initials: M
authors.lastname: Vijayan
authors.affiliation: Macaulay Honors College, New York, NY, USA.
authors.forename: Saranya
authors.initials: S
authors.lastname: Radhakrishnan
authors.affiliation: Pondicherry Institute of Medical Science, Pondicherry, India; Madras Medical Mission Hospital, Chennai, India; Tamil Nadu Kidney Research (TANKER) Foundation, Chennai, India.
authors.forename: Georgi
authors.initials: G
authors.lastname: Abraham
authors.affiliation: Pondicherry Institute of Medical Science, Pondicherry, India.
authors.forename: Milly
authors.initials: M
authors.lastname: Mathew
authors.affiliation: Meenakshi Mission Hospital and Research Center, Madurai, India.
authors.forename: Krishnaswamy
authors.initials: K
authors.lastname: Sampathkumar
authors.affiliation: Pondicherry Institute of Medical Science, Pondicherry, India.
authors.forename: Nevin Philip
authors.initials: NP
authors.lastname: Mancha
keywords: diabetic kidney disease; hemodialysis; socioeconomic class; survival analysis