PROGNOSIS OF DIABETIC-PATIENTS ON DIALYSIS - ANALYSIS OF LOMBARDY REGISTRY DATA

Methods. This 1993 Lombardy Registry Report refers to all of the data regarding treated diabetics collected between 1 January 1983 and 31 De cember 1992 by means of individual patient questionnaires sent to all of Lombardy's 44 Renal Units (100% replies). Results. The acceptance r ate of diabetics for dialysis increased from 5.6 in 1983 to 10.4 patie nts per million population in 1992 for a total of 731 patients (379 ty pe I, 352 type II). The yearly percentage of new diabetics increased f rom 9 to 11%, and the proportion of patients with two or more risk fac tors increased from 14.7% in 1983-1987 to 22.0% in 1988-1992. The use of peritoneal dialysis declined over the 10-year period from 50% in 19 83-1984 to 30% in the last 2 years. The difference in age of the patie nts on peritoneal and haemodialysis tended to decrease. The survival o f all diabetic patients was 82% at 1 year, 48% at 3 years, and 28% at 5 years. The relative death risk of the patients on peritoneal dialysi s compared to those on haemodialysis, after taking into account age an d the main comorbid conditions (type of diabetes, severe vascular dise ase, cirrhosis and the generic other risk factors), did not differ sig nificantly from one, as estimated by the Cox proportional hazard regre ssion model (344 events). The main causes of death of these patients w ere cardiovascular diseases (about 50.0%), cachexia (from 17.2% in 198 3/1984 to 22% in 1991/1992), and infections (about 11%). The mean hosp italization rate was higher in diabetics than in patients with standar d nephropathies (i.e. in 45-64-year-old patients: 32.8 versus 13.9 day s/patient-year). Conclusion. Multivariate analysis showed that age, ty pe of diabetes, severe vascular disease, cirrhosis, and the generic ot her risk factors were significantly related to survival; but diabetic patients without any baseline risk factors also had a poor prognosis a nd morbidity was very high in absolute terms. Medical care therefore n eeds to be improved in order to reverse prognostic risk factors and pr event cardiovascular and noncardiovascular events.