Current status of Type 2 (non-insulin-dependent) diabetic subjects on dialysis therapy in Japan

Abstract

According to a national survey of dialysis patients in Japan conducted by the Japanese Society for Dialysis Therapy, there were 1,033 patients on dialysis in the Shiga area which has a population of about 1.2 million. Of these 1,033 dialysis patients 140 were the result of diabetic nephropathy. From four hospitals affiliated to Shiga University of Medical Science the medical records of 90 diabetic subjects on dialysis therapy were reviewed and various clinical parameters were analysed and compared with those of patients with chronic glomerulonephritis. Since only one patient had Type 1 (insulin-dependent) diabetes, the remaining 89 with Type 2 (non-insulin-dependent) diabetes were used for this study. The significantly different variables between patients with Type 2 diabetes and chronic glomerulonephritis were age (60.4 vs 54.6 years, p < 0.05), BMI (22.4 vs 20.6 kg/m2, p < 0.001), cardiothoracic ratio (56.4 vs 53.3%, p < 0.001), mean blood pressure (110 vs 117 mmHg, p < 0.05), serum creatinine (9.0 vs 11.5 mg/dl, p < 0.001), serum urea-N (98.2 vs 115.5 mg/dl, p < 0.001), serum total protein (6.0 vs 6.5 g/dl, p < 0.001) and serum albumin (3.5 vs. 3.9 g/dl, p < 0.001). Serum levels of cholesterol and triglyceride were not significantly different between two groups, though the prevalence of electrocardiogram abnormalities, oedema, neuropathy, myocardial infarction and cerebrovascular diseases was significantly higher in the Type 2 diabetic group. These results suggested that Type 2 diabetic patients with end-stage renal disease were older, more malnourished, fluid overloaded and multi-morbid as a result of vasculopathy and neuropathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Glycemic Control Is a Predictor of Survival for Diabetic Patients on Hemodialysis

“…Contrary to our expectation before data analyses, we failed to find significant differences in the frequency of cardiovascular disease as cause of death between the good and poor glycemic control groups. Infectious diseases accounted for 20% of all the deaths of our subjects, a percentage comparable with that in previous reports (11,13,16). The frequency of infectious diseases in the G group was one-third that in the P group.…”

“…Cardiovascular causes accounted for ϳ43% of deaths for our subjects, a percentage comparable with that in a study in Japan (16) and lower than that in a study in the U.S. (21). Contrary to our expectation before data analyses, we failed to find significant differences in the frequency of cardiovascular disease as cause of death between the good and poor glycemic control groups.…”

“…In previous studies, older age, malnutrition (14,16), dyslipidemia (17,18), and coexistence of cardiovascular disease (11,12,14,15) were reported to affect the survival rate of diabetic ESRD patients after the initiation of hemodialysis. The most common cause of death of diabetic patients with ESRD as well as of diabetic patients without ESRD is cardiovascular disease.…”

“…Several studies identified clinical predictors of survival of diabetic end-stage renal disease (ESRD) patients on hemodialysis, including age at hemodialysis initiation (11)(12)(13)(14)(15), nutritional status (14,16), dyslipidemia (17,18), and existence of cardiovascular complications (11,12,14,15). However, it is still unknown whether glycemic control has beneficial effects in diabetic patients with advanced nephropathy.…”

Epidemiologic Analysis of Diabetic Patients on Chronic Dialysis

“…The proportion of the patients with IDDM is lower than reported in previously per formed studies [1,3,4], but higher than in a study con ducted in another part of Japan [21], The term type I dia betes (IDDM) reported in the USRDS means simply that the majority in this patient group require insulin, but does not necessarily mean IDDM [3,22], IDDM was formerly suspected to make the greater contribution to end-stage renal disease among DM patients. However, subsequent studies have demonstrated that in the majority of DM patients with end-stage renal disease it is secondary to NIDDM.…”