engleski

Comparison of survival between diabetic and non-diabetic patients on maintenance hemodialysis : a single-centre experience experience

To analyze survival rates of diabetic and non-diabetic patients undergoing haemodialysis during a six-year follow-up, and to evaluate, and compare risk factors predicting survival. We analyzed survival rates of 144 prevalent patients on maintenance haemodialysis at the Department of Nephrology and Dialysis, Rijeka University Hospital, Rijeka, Croatia, from1998 to 2003. Included were only end-stage renal disease patients on maintenance haemodialysis treatment dialysed more than six months before entering the study, and who were clinically stable. Exclusion criteria were haemodialysis because of acute renal failure ; kidney transplantation ; peritoneal dialysis as a renal replacement therapy at any time before randomization. The patients were randomized in two groups according to the presence or absence of diabetic nephropathy as the cause of ESRD, and followed-up. The patient's death as outcome measure was recorded. The survival rates were estimated by the Kaplan-Meier method. The major causes of death were cardiovascular disease in 40 (60.6%)patients. An acute myocardial infarction in 15 (22.7%) patients was the major single cause of death. We found a significantly lower survival of diabetic patients than nondiabetic patients (P=0.0013). The most important predictors of death among diabetic patients on maintenance haemodialysis were hyperglycaemia (P<0.001), ischaemic heart disease (P=0.004), hypercholesterolemia (P=0.013), and low delivered dialysis dose (P=0.013). We demonstated that survival of diabetic patients undergoing haemodialysis was much worse than survival of non-diabetic patients. The cardiovascular disease remained the major cause of death in both groups. Early detection of pre-existing cardiovascular risk factors and diseases, and treatment of infections leading to sepsis, are of great importance, as they may influence the survival rates. Intensive management of diabetic patients is essential.

cardiovascular diseases; diabetic nephropathy; hemodialysis; risk factors

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