Epidemiology and Mortality of New-Onset Diabetes After Dialysis

Tien, Kai‐Jen; Lin, Zhe-Zhong; Chio, Chung-Ching; Wang, Jhi‐Joung; Chu, Cordia Ming-Yeuk; Sun, Yung-Nien; Kan, Wei‐Chih; Chien, Chih-Chiang

doi:10.2337/dc12-2148

Cited by 52 publications

(70 citation statements)

References 29 publications

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“…Since new-onset diabetes and IGT (NODI) is a common complication among patients on dialysis (4)(5)(6)8), it is important to explore the potential risk factors for this complication. However, published data on this issue are limited in dialysis populations.…”

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confidence: 99%

“…A previous study has indicated the potential side effects of dialysate glucose including a tendency for hyperglycemia and hyperinsulinemia in a dose-dependent manner in PD patients (14). However, 2 recent papers did not compare the higher risk for new-onset diabetes in PD populations with their hemodialysis (HD) counterpart (6,7). It is therefore of interest to explore the potential effect of the amount of dietary energy intake and glucose absorption via dialysate on the incidence of NODI in PD patients.…”

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confidence: 99%

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Older Age, Higher Body Mass Index and Inflammation Increase the Risk for New-Onset Diabetes and Impaired Glucose Tolerance in Patients on Peritoneal Dialysis?

2016

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N ew-onset diabetes and impaired glucose tolerance (IGT) have been shown to be associated with increased cardiovascular events and risk of death in the general population (1-3) and in patients undergoing dialysis (4-7). Since new-onset diabetes and IGT (NODI) is a common complication among patients on dialysis (4)(5)(6)8), it is important to explore the potential risk factors for this complication. However, published data on this issue are limited in dialysis populations.To our knowledge, traditional risk factors, such as age, male gender, obesity, hypertension, and hyperlipidemia, have been recognized to increase the risk for new-onset diabetes in the general population (9-11). These traditional factors, as well as uremia-related factors including malnutrition, inflammation, and comorbidities, have previously shown to be associated with new-onset diabetes, IGT, or fasting hyperglycemia in dialysis patients in 2 cross-sectional (4,8) and 2 longitudinal cohort datasets, respectively (6,7). However, the above parameters were collected at baseline or at a single timepoint in these studies, which makes it impossible to analyze the association between time-varying variables and outcomes. In addition, glucose is inevitably used as an osmotic agent in all commercial solutions for PD patients in China, accounting for about 20% of total energy intake (12,13). A previous study has indicated the potential side effects of dialysate glucose including a tendency for hyperglycemia and hyperinsulinemia in a dose-dependent manner in PD patients (14). However, 2 recent papers did not compare the higher risk for new-onset diabetes in PD populations with their hemodialysis (HD) counterpart (6,7). It is therefore of interest to explore the potential effect of the amount of dietary energy intake and glucose absorption via dialysate on the incidence of NODI in PD patients.All of the above mentioned contributors actually exist at the start of PD therapy and then vary to different degrees during follow-up. To determine the critical contributors to NODI, baseline characteristics and time-dependent variables need to be analyzed in Cox regression models. In this paper, we report a prospective cohort study to explore the incidence and risk factors for NODI, taking baseline and time-dependent covariates into account. METHODS SUBJECT SELECTIONAll the non-diabetic incident patients on chronic PD between August 2003 and August 2011 were enrolled in this This single copy is for your personal, non-commercial use only. For permission to reprint multiple copies or to order presentation-ready copies for distribution, contact Multimed Inc. at marketing@multi-med.com 278 DONG et al. MAY 2016 -VOL. 36, NO. 3 PDI study. All patients visited with a physician at least once every 3 months. All subjects began the PD program within 1 month after catheter implantation and were given lactate-buffered glucose dialysate with a twin-bag connection system (Baxter Healthcare, Guangzhou, China). This study was approved by the Medical Ethics Committee of Peking ...

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Older Age, Higher Body Mass Index and Inflammation Increase the Risk for New-Onset Diabetes and Impaired Glucose Tolerance in Patients on Peritoneal Dialysis?

2016

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“…Several studies have reported that NODM occurs among patients receiving dialysis at rates greater than in the general population [7][8][9] . According to the Centre for Disease Control's web page 11 , the incidence rate for DM in the general population in the US fluctuated around 0.5%-0.9% per year from 2000 to 2009.…”

Section: Epidemiology Of New-onset Diabetes Mellitus After Dialysismentioning

confidence: 99%

“…In recent years, new-onset diabetes mellitus (NODM) after the initiation of dialysis has been reported in several studies [7][8][9][10] . This critical review focuses on the epidemiology and risk factors of NODM after dialysis.…”

Section: Introductionmentioning

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Epidemiology of new-onset diabetes mellitus after dialysis

Chien¹,

Kan²,

Ym³

et al. 2013

OA Nephrology

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IntroductionDiabetic nephropathy is the leading cause of end-stage renal disease in patients undergoing dialysis. Most studies evaluate the association between pre-existing diabetes mellitus, but very few focus on newonset diabetes mellitus after dialysis. Chronic dialysis patients are often older and have multiple comorbidities, including cardiovascular diseases and pancreatic disorder. In addition, these patients have been found to be in a state of chronic inflammation. These characteristics have been associated with the development of insulin resistance and diabetes. Herein, we critically review the epidemiology, risk factors and mortality of new-onset diabetes mellitus after dialysis. ConclusionThe dialysis population has a higher incidence of new-onset diabetes mellitus and a greater risk of mortality than the general population. In addition, the post-transplant incidence of diabetes mellitus, which always occurs the first year after transplant, is much higher than the pre-transplant incidence. However, dialysis modality does not appear to be associated with new-onset diabetes mellitus after dialysis and post-transplant. The independent predictors of newonset diabetes mellitus are old age, cardiovascular comorbidity and dyslipidemia. Other possible contributing factors are inflammation and use of some commonly prescribed drugs for cardiovascular disease, such as statin. Physicians may need to pay more attention to the possibility of new-onset diabetes mellitus when treating high-risk patients undergoing dialysis.

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“…Additionally, for patients undergoing PD, obligatory carbohydrate absorption with PD solutions has been considered to be an additional potential risk. However, 2 recent studies from Taiwan have compared the risk of new-onset diabetes mellitus among incident hemodialysis and PD patients and have found either an equivalent or lower risk among patients starting PD (13,14). Beyond this comparison with hemodialysis, however, there remains a substantial gap in understanding regarding risk factors and predictors of new-onset diabetes for patients initiating PD therapy.…”

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confidence: 99%