Factors influencing survival of diabetic patients after initiation of renal replacement therapy

The survival of diabetic patients on dialysis treatment is poor but variabl e. The aim of this retrospective study was to determine factors that might predict the survival of such patients in our own unit. Data from 96 patient s with diabetic renal disease (biopsy proven or clinically suspected), who had commenced dialysis after 1980, were included in a retrospective surviva l analysis. Age, gender, ethnicity, diabetes type, co-morbidity and factors relevant to dialysis provision and subsequent management were considered. The analysis involved the fitting of suitable Cox proportional hazards mode ls using the S-plus statistical software package. According to our model, c ontinued use of angiotensin-converting enzyme (ACE) inhibitor medication an d renal replacement with peritoneal dialysis (PD) conferred a survival adva ntage. In addition, analysis of survival curves showed a significantly bett er outcome for insulin-dependent diabetic patients, patients on PD and thos e treated with ACE inhibitor medication. PD may have been associated with i mproved survival because of its preferential use in younger and fitter diab etic patients (mean age of PD patients at initiation of dialysis 50.3 years compared with 61.6 years for haemodialysis patients). Treatment with ACE i nhibitor medication appears to be beneficial and should therefore be consid ered in all cases.