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[Results of chronic hemodialysis treatment in patients with diabetic nephropathy]
B H Watschinger1, I Kührer, G Mayer
1II. Medizinische Universitätsklinik, Wien.
Insights
Diabetics on haemodialysis (HD) experience higher hospitalization rates and poorer survival, particularly Type II diabetics. This is due to disease progression, not dialysis inefficiency.
Area of Science:
- Nephrology
- Diabetology
- Clinical Medicine
Context:
- Diabetic nephropathy is a leading cause of end-stage renal disease.
- Haemodialysis (HD) is a common treatment for kidney failure in diabetic patients.
- Outcomes for diabetics on HD require further investigation.
Purpose:
- To compare morbidity and mortality in diabetic versus non-diabetic patients undergoing HD.
- To analyze survival rates, hospitalization, and causes of death.
- To assess blood chemistry differences during dialysis.
Summary:
- Retrospective analysis of 12 diabetic and 14 non-diabetic HD patients matched for key demographics.
- No significant blood chemistry differences, except creatinine, were observed.
- Diabetic patients had significantly more hospitalizations (1.8 vs 0.9 days/month) due to vascular access complications and infections.
- 3-year survival was 73% for Type I diabetics (vs 93% controls); Type II diabetics had <24 months survival.
- Cardiovascular and septic complications were the leading causes of death in diabetic patients.
Impact:
- Highlights the significantly higher morbidity and mortality in diabetic patients on HD.
- Suggests that multisystemic diabetic disease progression, not HD procedure, dictates poor prognosis.
- Informs clinical management and patient counseling for diabetics requiring renal replacement therapy.
Abstract:
In order to evaluate the differences in morbidity and mortality of diabetics on haemodialysis (HD), data on 12 patients with diabetic nephropathy and 14 non-diabetic patients have been analyzed retrospectively since 1982. The groups were matched for sex, age and duration of HD. We analyzed the differences in survival rate, the number of hospitalization days and the causes of death. Values of BUN, creatinine, calcium, phosphate, cholesterol and triglycerides, alkaline phosphatase, erythrocyte count and haemoglobin were compared throughout the dialysis period. No significant differences occurred between the two groups as regards blood chemistry values (except for creatinine) throughout the observation period. The number of hospitalization days per month of dialysis was significantly different: 1.8 days in diabetic versus 0.9 days in non-diabetic patients (p less than 0.005). This difference is due to a higher rate of vascular access complications and infections. The 3-year survival rate on HD was 73% in type I diabetics (controls 93%), while none of the type II diabetics survived for more than 24 months on HD. The most common causes of death in the diabetic patients were cardiovascular (44%) and septic (44%) complications, followed by cerebrovascular problems (12%). We conclude from our study that the reason for the poor prognosis of diabetic patients on HD is not lack of efficiency of the procedure, but progression of the multisystemic diabetic condition.