Risk Factors Associated with All-Cause Death Among Dialysis Patients with Diabetes

BACKGROUND Patients receiving dialysis who also have diabetes mellitus have high mortality. This study aimed to investigate the risk factors associated with all-cause death among Polish patients with diabetes receiving dialysis. MATERIAL AND METHODS This prospective observational study included 100 patients with type 1 or type 2 diabetes who were treated with peritoneal dialysis or hemodialysis. Blood laboratory tests, the occurrence of diabetes complications, and comorbidity, using the Charlson Comorbidity Index, were estimated. Survival analysis was performed using the multivariate Cox proportional hazard model, and Kaplan-Meyer survival analyses with log-rank tests were performed to show differences between groups. RESULTS During 16.0±5.0 months, 23 patients died. The deceased group had significantly higher levels of HbA1c (P=0.046) and fructosamine (P=0.011) than the surviving group. The deceased patients also had higher comorbidity scores (P=0.013). In the stepwise multivariate Cox proportional hazard regression model, history of stroke or transient ischemic attack was an independent risk factor of all-cause death (hazard ratio [HR] 3.15, 95% CI 1.34-7.39; P=0.009), while regular physical activity significantly reduced the risk of all-cause death (HR 0.26, 95% CI 0.08-0.87; P=0.029). CONCLUSIONS Deceased patients had higher HbA1c and fructosamine levels and higher comorbidity. However, history of stroke or transient ischemic attack was an independent risk factor of all-cause death, while regular physical activity was associated with the reduction of the risk of all-cause death in patients with type 1 and type 2 diabetes treated with peritoneal dialysis or hemodialysis. Regular physical activity should be recommended to improve survival in this population.