THE IMPACT OF DIABETES ON PATIENTS SURVIVAL IN DIALYSIS PATIENTS WITHNONDIABETIC RENAL-DISEASE AND IN PATIENTS WHO DEVELOP DIABETES DURINGCHRONIC DIALYSIS

Background. It is well known that dialysis patients with diabetic neph ropathy have a poor prognosis, but data concerning the survival of dia lysis patients with diabetes plus a non-diabetic primary nephropathy o r the survival of patients who develop diabetes after the start of reg ular dialysis are scarce. Aim and methods. We reviewed the survival of two cohorts of dialysis patients in whom diabetes mellitus was associ ated with non-diabetic primary nephropathy. In the first cohort (18 pa tients with a primary diagnosis of APKD) diabetes mellitus preceded hy perazotaemia, whilst the second cohort of 34 patients developed diabet es after the start of regular dialysis. We compared the survival of ea ch group of patients to the survival of a group of dialysis patients w ith a primary diagnosis of diabetic nephropathy, and to the survival o f a control group of non-diabetic dialysis patients. Within each case series, groups were similar according to age, sex, age at start of RRT , and place of treatment. All patients were selected among those alive on treatment at 31 December 1987 and were followed up to 31 December 1991. Results. In both case series the survival of patients with diabe tes was similar irrespective of the primary diagnosis (Lee-Desu statis tics: first cohort P=0.43; second cohort, P=0.08). Moreover, the survi val of patients either with diabetic nephropathy or with diabetes in a ssociation with non-diabetic primary nephropathy was significantly wor se compared to the survival of the non-diabetic patients (Lee-Desu sta tistics: first case series P=0.02 and P<0.01; second case series P<0.0 5 and P<0.01). Logistic regression showed that survival was negatively associated to diabetes and age but not to sex, duration of diabetes a nd diagnosis of diabetic nephropathy. Conclusions. Our limited data sh ow that the survival of diabetic patients on regular dialysis is poor, irrespective of the primary cause of renal failure and of the duratio n of diabetes. These data need confirmation and further study.