Long-Term Survivor Characteristics in Hemodialysis Patients with Type 2 Diabetes

Abstract

Background: Data concerning long-term mortality predictors among large, purely diabetic hemodialysis collectives are scarce. Methods: We used data from a multicenter, prospective, randomized trial among 1,255 hemodialysis patients with type 2 diabetes mellitus (T2DM) and its observational follow-up study. The association of 10 baseline candidate variables with mortality was assessed by Cox proportional hazards regression. Results: Overall, 103 participants survived the median follow-up of 11.5 years. Significant predictors of mortality were age (hazard ratio [HR] 1.03, 95% CI 1.02–1.04), cardiovascular (HR 1.42, 95% CI 1.25–1.62) and peripheral vascular disease (HR 1.55, 95% CI 1.36–1.76), higher hemoglobin A1c (HbA1c; HR 1.08, 95% CI 1.03–1.14), and loss of self-dependency (HR 1.20, 95% CI 1.03–1.39). Higher albumin (HR 0.72, 95% CI 0.59–0.89) and body mass index (BMI; HR 0.98, 95% CI 0.96–0.99) had protective associations. There was no significant association with sex, diabetes duration, and cerebrovascular diseases. Subgroup analyses by age and diabetes duration showed stronger associations of cardiovascular disease, HbA1c, albumin, BMI, and loss of self-dependency in younger patients and/or shorter diabetes duration. Loss of self-dependency and energy resources (albumin, BMI) increased mortality more severely in women, whilst the impact of cardiovascular and peripheral vascular diseases was more pronounced in men. Conclusion: Long-term mortality risk in patients with T2DM on hemodialysis was associated with higher age, vascular diseases, HbA1c, loss of self-dependency, and low energy resources. Interestingly, it does not vary between sexes. Further individualized prognosis estimation and therapy should strongly depend on age, diabetes duration, and gender.

High Incidence of Adverse Outcomes in Haemodialysis Patients with Diabetes with or without Diabetic Foot Syndrome: A 5-Year Observational Study in Lleida, Spain

“…However, age and retinopathy were the only risk factors for all-cause mortality among the subcohort of DM patients, and only age was predictive of CV mortality. In line with our results, a study on the characteristics of patients with DM that survived up to 11 years on HD showed that the risk of mortality increased by 3% per year increase in age [39]. Moreover, diabetic retinopathy was previously identified as an independent predictor of 3-year all-cause mortality among HD patients [40].…”

Fully closed-loop insulin delivery improves glucose control of inpatients with type 2 diabetes receiving hemodialysis

“…Findings from observational studies are inconsistent. Although the study with the longest follow-up showed a clear association between high glycated hemoglobin and all-cause mortality, 16 this relationship was found to be either only in patients younger than 60 years 17 or without support. 18 In addition to the unclear accuracy of measures of glycated hemoglobin in dialysis patients, 19 assessments can be challenged by hypoglycemia, which is similarly associated with adverse events.…”

Risk factors for cardiovascular and cerebrovascular events in patients with uremia and hypertension during maintenance hemodialysis

“…The relationship between blood pressure during dialysis and mortality risk is U-shaped, with both elevated and low post-dialysis SBP levels being associated with a higher risk of cardiovascular death, and the mortality is significantly increased when the DBP is greater than 109 mmHg [14]. MACCEs are important causes of death in uremic patients during MHD [15]. In this study, patients with uremia and refractory hypertension were included and the incidence of MACCEs was found to be 48.08%, similar to the results of previous studies [16].…”