Prognostic factors in Brazilian diabetic patients starting dialysis - A 3.6-year follow-up study

The objective of this study was to analyze the prognostic factors of a coho rt of diabetic patients starting dialysis. This prospective, 3,6-year popul ation-based cohort study included 111 diabetic patients starting dialysis i n all 18 dialysis centers of the metropolitan area of Porto Alegre, Brazil, between July 1995 and October 1996. The survival rate was analyzed by Kapl an-Meier curves and prognostic factors for death by Cox's proportional-haza rds model. During the study period, 685 patients started dialysis; 182 (26. 5%) had diabetes and 111 patients were included. Eighty-four percent of the 111 patients were classified as type 3 diabetes (random C-peptide>0.6 ng/m l), and these patients presented more coronary artery disease (60% vs. 29%; P<0.02:) than type 1 patients. In type 2 patients, later diagnosis of diab etes was associated with a shorter interval until beginning of dialysis (r = 0.67; P = 0.001). Diabetic nephropathy was the primary renal disease in 6 1% of all patients. Overall median survival (26 months) was similar for typ es 1 and 2 diabetic patients. Survival in the first, second, and third year was 69%, 51%, and 28%, respectively. Cardiovascular disease was the most c ommon cause (63%) of death. According to Cox's proportional-hazards model, history of stroke (HR: 4.53, CI: 2.09-9.86, P < 0.0001), amputations (HR: 3 .2, CI: 1.61-6.35, P < 0.0009), and coronary artery disease (HR: 1.67, CI: 0.95-2.96, P < 0.076) at baseline were significantly associated with mortal ity. In conclusion, macrovascular complications were the main predictors of mortality in this cohort of diabetic patients starting dialysis. Intensive treatment of cardiovascular risk factors during dialysis might reduce the mortality rate of diabetic patients. (C) 2000 Elsevier Science Inc. All rig hts reserved.