Related Experiment Videos
[Experience with chronic hemodialysis in diabetic patients with kidney failure]
Insights
Diabetic patients on hemodialysis have a lower survival rate, especially those with poor metabolic control before dialysis. Cardiovascular issues and infections are leading causes of death in this population.
Area of Science:
- Nephrology
- Diabetology
- Public Health
Context:
- Chronic kidney disease (CKD) patients often require hemodialysis (HD).
- Diabetes mellitus is a major comorbidity in CKD patients undergoing HD.
- Survival rates and risk factors in diabetic HD patients require ongoing investigation.
Purpose:
- To evaluate the survival rates of diabetic patients undergoing chronic hemodialysis (HD).
- To identify factors influencing mortality in diabetic patients on HD.
- To compare outcomes between different types of diabetes and metabolic control.
Summary:
- A study of 534 patients, including 35 diabetics, on chronic hemodialysis (HD) found a significantly lower 1-year cumulative survival rate (CSR) in diabetics (66%) compared to non-diabetics (78%).
- Major causes of death were cardiovascular complications (39%) and infections (33%).
- Good metabolic control from diabetes onset was associated with higher CSR (80% vs. 62%).
Impact:
- Findings highlight the increased mortality risk for diabetic patients on HD.
- Emphasizes the importance of pre-dialysis metabolic control in improving survival outcomes.
- Informs clinical practice regarding risk stratification and management of diabetic CKD patients.
Abstract:
Between 1978 and 1992, 534 patients--including 35 (25 IDDM and 10 NIDDM) diabetics--were accepted to chronic hemodialysis (HD) at our Dialysis Center. The 1-year cumulative survival rate (CSR) was significantly lower in diabetic vs. non-diabetic group (66 +/- 8% vs. 78 +/- 2%), p < 0.05). At the onset of diabetes the mean age of IDDM patients vs. NIDDM patients was 18.2 +/- 2.7 years vs. 51.3 +/- 3.1 years, respectively. At the beginning of HD treatment the mean age of IDDM patients vs. NIDDM patients was 38 +/- 2.4 years vs. 58.3 +/- 2.6 years. In IDDM group until the start of HD treatment the mean duration of diabetes was 20 +/- 1.3 years and it did not depend on the quality of preuraemic metabolic control (p = 0.825); mean duration of diabetes until their death was 22.5 +/- 1.3 years. Mean age of IDDM and NIDDM patients at their death was 38.8 +/- 3 years and 60.5 +/- 3.7 years. Average duration of HD treatment was 16 +/- 2.5 months in IDDM group and 21.5 +/- 5.8 months in NIDDM group. Major causes of death were cardiovascular complications of diabetes (39%) and infections (33%). We found no difference in CSR related to gender, age, type of diabetes, quality of metabolic control during the HD treatment, but CSR was significantly higher in patients with good metabolic control from the onset of diabetes (1-year CSR of adequately vs. poorly controlled diabetics: 80% vs. 62%, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)