Effect of Renal Diseases and Comorbid Conditions on Survival in Chronic Dialysis Patients

Iseki, Kunitoshi; Nishime, Keizo; Uehara, Hajime; Osawa, Akira; Fukiyama, Koshiro

doi:10.1159/000188224

Cited by 19 publications

(15 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although our multivariable adjusted hazard ratio of 1.37 is smaller than their pooled estimate, our diabetes sample had relatively good glycaemic control, and only 20% of patients with diabetes had HbA 1c levels ≥7.3% (fifth quintile). Although actual glycaemic control was not described in the original articles cited in their review [16][17][18][19][20][21][22][23][24][25][26], the different glycaemic control may explain the different estimates of mortality risk.…”

Section: Discussionmentioning

confidence: 99%

Diabetes, glycaemic control and mortality risk in patients on haemodialysis: the Japan Dialysis Outcomes and Practice Pattern Study

et al. 2007

View full text Add to dashboard Cite

Aims/hypothesis There are few data on the target level of glycaemic control among patients with diabetes on haemodialysis. We investigated the impact of glycaemic control on mortality risk among diabetic patients on haemodialysis. Subjects and methods Data were analysed from the Dialysis Outcomes Practice Pattern Study (DOPPS) for randomly selected patients on haemodialysis in Japan. The diagnosis of diabetes at baseline and information on clinical events during follow-up were abstracted from the medical records. A Cox proportional hazards model was used to evaluate the association between presence or absence of diabetes, glycaemic control (HbA 1c quintiles) and mortality risk. Results Data from 1,569 patients with and 3,342 patients without diabetes on haemodialysis were analysed. Among patients on haemodialysis, those with diabetes had a higher mortality risk than those without (multivariable hazard ratio 1.37, 95% CI 1.08-1.74). Compared with those in the bottom quintile of HbA 1c level, the multivariable-adjusted hazard ratio for mortality was not increased in the bottom second to fourth quintiles of HbA 1c (HbA 1c 5.0-5.5% to 6.2-7.2%), but was significantly increased to 2.36 (95% CI 1.02-5.47) in the fifth quintile (HbA 1c ≥7.3%). The effect of poor glycaemic control did not statistically correlate with baseline mortality risk (p=0.27). Conclusions/interpretation Among dialysis patients, poorer glycaemic control in those with diabetes was associated with higher mortality risk. This suggests a strong effect of poor glycaemic control above an HbA 1c level of about 7.3% on mortality risk, and that this effect does not appear to be influenced by baseline comorbidity status.

show abstract

Section: Discussionmentioning

confidence: 99%

Diabetes, glycaemic control and mortality risk in patients on haemodialysis: the Japan Dialysis Outcomes and Practice Pattern Study

et al. 2007

View full text Add to dashboard Cite

show abstract

“…Detailed information re garding the treatment regimen with both insulin and anti hypertensives was not available in this study. In a limited number of cases, renal failure in NIDDM patients has progressed independently of the degree of control of blood glucose, systemic blood pressure, and serum cholesterol concentrations [26] or the albuminuria status [29], The prognosis of diabetic patients has been poor, espe cially in those with hypoalbuminemia [6,7], Diabetic patients often have multiple comorbid conditions before starting dialysis [4,5], and these may be related to malnu trition. However, in this study, the presence of comorbid conditions increased the risk of death by only 5% (risk ratio 1.05, 95% confidence interval 0.74-1.50; table 4).…”

Section: Discussionmentioning

confidence: 99%

“…Japan (OK1DS Registry) [2,5,7,18]. The accep tance policy for chronic dialysis has been quite open, including patients with DM and the elderly.…”

Section: Methodsmentioning

confidence: 99%

Epidemiologic Analysis of Diabetic Patients on Chronic Dialysis

Saito¹,

Iseki²,

Nishime³

et al. 1996

Nephron

Self Cite

View full text Add to dashboard Cite

We retrospectively surveyed all of the available medical records of 404 (191 females and 213 males) chronic dialysis patients, of whom 16 (4%) had insulin-dependent diabetes mellitus (IDDM) and 388 (96%) non-insulin-dependent diabetes mellitus (NIDDM). The patients were among 2,214 dialysis patients in Okinawa, Japan, of whom 443 were diabetic. The patients entered a large population-based dialysis registry. The mean duration from the diagnosis of diabetes mellitus (DM) to dialysis was 181.6 months in the IDDM patients and 150.4 months in the NIDDM patients. The NIDDM patients were classified into four subgroups according to their status when DM was first suspected. The duration from the diagnosis of DM until the onset of dialysis treatment was significantly shorter than in any other subgroup or in the IDDM subgroup with major vascular disease (131.9 months). Otherwise, the course of renal disease in NIDDM patients was similar to that in IDDM individuals. Most of our dialysis patients with DM had NIDDM. In most of the NIDDM patients, the diagnosis had been delayed for several years for unknown reason. However, if diagnosed early, NIDDM shows a clinical time course until dialysis similar to that of IDDM. Whether NIDDM patients contract chronic renal disease at an equal incidence to that of IDDM patients and the fraction of all diabetic patients accepted for chronic dialysis remain to be determined.

show abstract

“…7,8 To compare characteristics of patients with similar causes of ESRD, patients were divided into three groups: a chronic glomerulonephritis group, a diabetic nephropathy group, and an other renal diseases group.…”

Section: Data Handling and Classificationmentioning

confidence: 99%

Cardiovascular Risk Factors in Hemodialysis Patients: Results from Baseline Data of Kaleidoscopic Approaches to Patients with End-stage Renal Disease Study

Ohsawa

Kato

Itai

et al. 2005

Journal of Epidemiology

View full text Add to dashboard Cite

BACKGROUND: The prevalence of cardiovascular risk factors and the prevalence of comorbidities in adult hemodialysis patients in Japan are not fully understood. METHODS: In “Kaleidoscopic Approaches to Patients with End-stage Renal Disease Study” (The KAREN Study, 2003), trained research stuff examined 1,214 adult hemodialysis patients (mean age, 61.2 years; 779 males and 435 females) of 1,506 patients in northern areas of Iwate Prefecture. Cardiovascular risk factors and the prevalence of comorbidities in hemodialysis patients were compared with those in the general population using direct age-adjustment methodology and standardized morbidity ratios (SMRs). RESULTS: In hemodialysis patients, common causes of end-stage renal disease were chronic glomerulonephritis (29.8%), diabetic nephropathy (24.5%), and other diseases. Prevalence and SMR of myocardial infarction were 5% and 9.6, respectively, and those of stroke were 13% and 5.7. The prevalences of hypertension and diabetes mellitus were 87% and 29%, respectively. Mean systolic blood pressure and mean diastolic blood pressure were 155 mmHg and 85 mmHg, respectively. Mean levels of total serum cholesterol, high-density lipoprotein cholesterol, and albumin in patients with end-stage renal disease were lower than those of the general population (160.6 vs. 203.3 mg/dL, 48.5 vs. 59.7 mg/dL, and 3.7 vs. 4.4 g/dL, respectively). Mean levels of C-reactive protein were higher than those of the general population (3.80 vs. 1.16 mg/L). CONCLUSION: Hemodialysis patients have a high prevalence of cardiovascular risk factors and comorbidities. Levels of nutrition-related markers were lower, and C-reactive protein levels were higher, in hemodialysis patients than in the general population.

show abstract

Effect of Renal Diseases and Comorbid Conditions on Survival in Chronic Dialysis Patients

Cited by 19 publications

References 19 publications

Diabetes, glycaemic control and mortality risk in patients on haemodialysis: the Japan Dialysis Outcomes and Practice Pattern Study

Diabetes, glycaemic control and mortality risk in patients on haemodialysis: the Japan Dialysis Outcomes and Practice Pattern Study

Epidemiologic Analysis of Diabetic Patients on Chronic Dialysis

Cardiovascular Risk Factors in Hemodialysis Patients: Results from Baseline Data of Kaleidoscopic Approaches to Patients with End-stage Renal Disease Study

Contact Info

Product

Resources

About