J Nephropathol. 2017;6(2):81-89.
doi: 10.15171/jnp.2017.14
PMID: 28491858
PMCID: PMC5418075
Scopus id: 85008487985
  Abstract View: 1682
  PDF Download: 1093

Original Article

Clinical outcomes and quality of life in hemodialysis diabetic patients versus non-diabetics

Tayebeh Soleymanian 1 * , Zeinab Kokabeh 1, Rozita Ramaghi 2, Alireza Mahjoub 2, Hassan Argani 3

1 Nephrology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
2 Nephrology Research Center, Shariati Hospital, Tehran University of Medical Sciences-International Branch, Tehran, Iran
3 Urology and Nephrology Research Center, Modares Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Corresponding author: Tayebeh Soleymanian, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Email: soleymanian@tums.ac.ir

Abstract

Background: Diabetes is the leading cause of end stage renal disease (ESRD) worldwide.

Objectives: We compared the clinical outcomes in diabetic patients on hemodialysis (HD) with non-diabetics.

Patients and Methods: Adult maintenance HD patients (N= 532) from 9 HD facilities were enrolled to this prospective cohort study in September 2012. Causes of death, hospitalization, and HD exit were recorded in a median 28 months follow up period.

Results. Forty-one percent of patients were diabetic. Diabetic patients compared to non-diabetics had significantly higher age (62.2 ± 11.2 versus 53.1 ± 16.7 years), lower dialysis duration (median: 23 versus 30 months), more cardiovascular comorbidities (64% versus 28%) , higher C-reactive protein (CRP) levels (median: 3.80 versus 2.25 mg/L), lower serum albumin (3.86 ± 0.35 versus 3.93 ± 0.35 g/dL), lower intact parathyroid hormone (iPTH) (median: 272 versus 374 ρg/mL), higher serum triglyceride (167 ± 91 versus 139 ± 67 mg/dL) and low density lipoprotein (LDL) (82.5 ± 24.5 versus 77.5 ± 23.8 mg/dL), and worse short form health survey (SF36) score (45.7 ± 20.9 versus 52.7 ± 20.5). Annual admission rate was higher in diabetics (median: 0.86 versus 0.43) and diabetic foot involved 16% of their admissions. Transplantation rate was 4 and 9 per 100 patient years in diabetics and non-diabetics, respectively. Death rate was two folds higher in diabetics (24 versus 12 per 100 patient years). Cardiovascular diseases ( ± infections/other causes) comprised 80.5% of death in diabetics and 54.5% in non-diabetics. In Cox regression proportional hazard multivariate analysis, hazard risk of death in diabetics was 1.9 times higher than non-diabetics.

Conclusions: Clinical outcomes and health related quality of life (HRQOL) are much worse in diabetic compared to non-diabetic HD patients mainly due to more frequent of cardiovascular diseases (CVDs).

Implication for health policy/practice/research/medical education:

Diabetic nephropathy is the leading cause of ESRD worldwide. We tried to define patients characteristics, common causes of death and its’ risk factors in diabetic HD patients in order to delineate intervensions which could potentially help to improve patients’ quality of life and survival.

Please cite this paper as: Soleymanian T, Kokabeh Z, Mahjoub A, Ramaghi R, Argani H. Clinical outcomes and quality of life in hemodialysis diabetic patients versus non-diabetics. J Nephropathol. 2017;6(2):81-89. DOI: 10.15171/jnp.2017.14.

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First published online: 14 Dec 2016
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