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

Abstract

BackgroundDiabetes is the leading cause of end stage renal disease (ESRD) worldwide.ObjectivesWe compared the clinical outcomes in diabetic patients on hemodialysis (HD) with non-diabetics.Patients and MethodsAdult 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.ResultsForty-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.ConclusionsClinical 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).

Chronic Kidney Disease Worsens Health Outcomes in Diabetic Patients After Hip Fracture Surgery: An Asian Nationwide Population-Based Cohort Study

“…(53) Meanwhile, compared with nondiabetics, the diabetic dialysis patients had higher readmission rates, mortality rates, and worse life quality because of more frequent cardiovascular events. (54,55) Similarly, our study found that the diabetic dialysis group had a higher incidence of cardiovascular diseases, including coronary arterial disease and congestive heart failure compared with nondiabetics. However, in contrast to previous studies, the current study showed that the diabetic group had similar risks of readmission and mortality all time-points except 1 year after hip fracture fixation surgery compared with the nondiabetic dialysis group.…”

Patients’ perceptions of their experience, control and knowledge of fluid management when receiving haemodialysis

“…Whilst Soleymanian et al . () found no significant differences in bodily pain between diabetic and non‐diabetic haemodialysis patients, in our study it was reported that when diabetes was not under control, this could increase patients’ perception of pain during haemodialysis. Therefore, during times where diabetic patients have poor control over their diabetes, they may need additional support to ensure they are able to remove enough fluid without being in substantial pain.…”

The Impact of Blood Flow Rate and Duration of Dialysis Session on Nutritional Status in Hemodialysis Patients

“…These patients have nutritional markers of serum creatinine, and albumin was inferior to non-diabetics. In fact, diabetic patients are faced with malnutrition due to low protein intake and higher catabolic state (Soleymanian, Kokabeh, Mahjoub, Ramaghi, & Argani, 2017). Unfortunately, in our study, the proportion of diabetes as a cause of ESRD was not the same between groups, where the proportion of diabetes was highest in group III significantly (Table 1).…”

“…In terms of vascular access, there is a trend towards higher catheter utilization in diabetic patients (Soleymanian et al, 2017). Catheter use is accompanied by a lack of adequate dialysis and a higher risk of infection and inflammation, potentially affecting the survival of HD patients (Coentrao et al, 2015).…”