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Survival in dialysis patients is different between patients with diabetes as primary renal disease and patients with diabetes as a co-morbid condition

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Abstract

Aims/hypothesis

A previous study in Dutch dialysis patients showed no survival difference between patients with diabetes as primary renal disease and those with diabetes as a co-morbid condition. As this was not in line with our hypothesis, we aimed to verify these results in a larger international cohort of dialysis patients.

Methods

For the present prospective study, we used data from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry. Incident dialysis patients with data on co-morbidities (n = 15,419) were monitored until kidney transplantation, death or end of the study period (5 years). Cox regression was performed to compare survival for patients with diabetes as primary renal disease, patients with diabetes as a co-morbid condition and non-diabetic patients.

Results

Of the study population, 3,624 patients (24%) had diabetes as primary renal disease and 1,193 (11%) had diabetes as a co-morbid condition whereas the majority had no diabetes (n = 10,602). During follow-up, 7,584 (49%) patients died. In both groups of diabetic patients mortality was higher compared with the non-diabetic patients. Mortality was higher in patients with diabetes as primary renal disease than in patients with diabetes as a co-morbid condition, adjusted for age, sex, country and malignancy (HR 1.20, 95% CI 1.10, 1.30). An analysis stratified by dialysis modality yielded similar results.

Conclusions/interpretation

Overall mortality was significantly higher in patients with diabetes as primary renal disease compared with those with diabetes as a co-morbid condition. This suggests that survival in diabetic dialysis patients is affected by the extent to which diabetes has induced organ damage.

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Abbreviations

ERA-EDTA:

European Renal Association-European Dialysis and Transplant Association

ESRD:

End-stage renal disease

HD:

Haemodialysis

NECOSAD:

Netherlands Cooperative Study on the Adequacy of Dialysis

PD:

Peritoneal dialysis

RRT:

Renal replacement therapy

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Acknowledgements

The ERA-EDTA Registry is funded by the ERA-EDTA. We would like to thank the patients and staff of all the dialysis units who contributed data via their national and regional renal registries. In addition, we would like to thank the following persons for their contribution to the work of the ERA-EDTA Registry: R. Kramar (Austrian Dialysis and Transplant Registry), J. Comas (Catalan Renal Registry) and G. A. Ioannidis (Hellenic Renal Registry) for providing the data for this study; ERA-EDTA Registry committee members (R. Vanholder, Belgium [ERA-EDTA president], C. Wanner (Germany, [Registry chairman]), D. Ansell (UK), C. Combe (France), L. Garneata (Romania) F. Jarraya (Tunisia), P. Ravani (Italy), R. Saracho (Spain), F. Schaefer (Germany), S. Schön (Sweden) and E. Verrina (Italy).

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Contribution statement

MAS, MWML, MN, FWD, KJJ and OMD were involved in design of the study, analysis and interpretation of the data, drafting the manuscript and revision of the manuscript based on comments from co-authors. PR, FJ, FC, KGP, DGF, TL, FCP and CW were involved in the design of the study, data collection, interpretation of the data and revision of the manuscript. All authors approved the final version of the manuscript.

Author information

Authors and Affiliations

  1. Department of Clinical Epidemiology, C7, Leiden University Medical Center, Albinusdreef 2, 2333, Leiden, the Netherlands

    M. A. Schroijen, F. W. Dekker & O. M. Dekkers

  2. Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, the Netherlands

    M. A. Schroijen & O. M. Dekkers

  3. ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center Amsterdam, Amsterdam, the Netherlands

    M. W. M. van de Luijtgaarden, M. Noordzij & K. J. Jager

  4. Division of Nephrology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada

    P. Ravani

  5. Department of Nephrology, Hédi Chaker Hospital, Sfax, Tunisia

    F. Jarraya

  6. French-Speaking Belgium ESRD Registry, Bruxelles, Belgium

    F. Collart

  7. Swedish Renal Registry, Jönköping, Sweden

    K. G. Prütz

  8. Nephrology Research Group, Centre for Public Health, Queen’s University and Regional Nephrology Unit, Belfast City Hospital, Belfast, UK

    D. G. Fogarty

  9. Norwegian Renal Registry, Renal Unit, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway

    T. Leivestad

  10. Department of Nephrology, 4th Internal Department, Klinikum Wels-Grieskirchen, Wels, Austria

    F. C. Prischl

  11. Department of Medicine I, Division of Nephrology, University of Würzburg, Würzburg, Germany

    C. Wanner

Authors
  1. M. A. Schroijen
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  2. M. W. M. van de Luijtgaarden
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  3. M. Noordzij
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  4. P. Ravani
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  5. F. Jarraya
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  6. F. Collart
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  7. K. G. Prütz
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  8. D. G. Fogarty
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  9. T. Leivestad
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  10. F. C. Prischl
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  11. C. Wanner
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  12. F. W. Dekker
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  13. K. J. Jager
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  14. O. M. Dekkers
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Corresponding author

Correspondence to M. A. Schroijen.

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Schroijen, M.A., van de Luijtgaarden, M.W.M., Noordzij, M. et al. Survival in dialysis patients is different between patients with diabetes as primary renal disease and patients with diabetes as a co-morbid condition. Diabetologia 56, 1949–1957 (2013). https://doi.org/10.1007/s00125-013-2966-1

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  • DOI: https://doi.org/10.1007/s00125-013-2966-1

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