The Impact of Type 2 Diabetes on Mortality in End-Stage Renal Disease Patients Differs between Genders

Karamé, A.; Labeeuw, M; Trolliet, Pierre; Caillette-Beaudoin, A.; Cahen, R; Écochard, René; Rb, Galland; Hallonet, P.; Pouteil‐Noble, Claire; Villar, Emmanuel

doi:10.1159/000224794

Cited by 22 publications

(7 citation statements)

References 61 publications

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“…The cardiovascular complications of DM contribute to the higher mortalities observed for diabetic patients [ 15 ]. Of the patients in the present study, 44% had DM, a higher percentage than those reported in other studies (range of 9% [ 12 ] to 22% [ 13 ]).…”

Section: Discussionmentioning

confidence: 99%

Parathyroidectomy Is Associated with Reduced Mortality in Hemodialysis Patients with Secondary Hyperparathyroidism

Hung

Jong

et al. 2015

BioMed Research International

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Secondary hyperparathyroidism increases morbidity and mortality in hemodialysis patients. The Kidney Disease Outcomes Quality Initiative Guidelines recommend parathyroidectomy for patients with chronic kidney disease and parathyroid hormone concentrations exceeding 800 pg/mL; however, this concentration represents an arbitrary cut-off value. The present study was conducted to identify factors influencing mortality in hemodialysis patients with parathyroid hormone concentrations exceeding 800 pg/mL and to evaluate the effects of parathyroidectomy on outcome for these patients. Two hundred twenty-one hemodialysis patients with parathyroid hormone concentrations > 800 pg/mL from July 2004 to June 2010 were identified. 21.1% of patients (n = 60) received parathyroidectomy and 14.9% of patients (n = 33) died during a mean follow-up of 36 months. Patients with parathyroidectomy were found to have lower all-cause mortality (adjusted hazard ratio [aHR]: 0.34). Other independent predictors included age ≥ 65 years (aHR: 2.11) and diabetes mellitus (aHR: 3.80). For cardiovascular mortality, parathyroidectomy was associated with lower mortality (HR = 0.31) but with a marginal statistical significance (p = 0.061). In multivariate analysis, diabetes was the only significant predictor (aHR: 3.14). It is concluded that, for hemodialysis patients with parathyroid hormone concentrations greater than 800 pg/mL, parathyroidectomy is associated with reduced all-cause mortality.

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Section: Discussionmentioning

confidence: 99%

Parathyroidectomy Is Associated with Reduced Mortality in Hemodialysis Patients with Secondary Hyperparathyroidism

Hung

Jong

et al. 2015

BioMed Research International

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“…In developed countries, population aging, inactivity, growing prevalence of obesity, and improved management of chronic complications have contributed to an epidemic of type 2 diabetes (T2DM) [4,18-23]. T2DM is particularly common among African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders [24].…”

Section: Study Descriptionmentioning

confidence: 99%

“…Diabetic nephropathy affects about 10-20% of people with diabetes [31,32] and is a leading cause of ESRD [21-23,31]. Furthermore, studies have shown that individuals with both diabetes and ESRD have higher morbidity and mortality rates than individuals with only one of these conditions [4,33,34]. Finally, it has also been reported that women with ESRD have worse outcomes compared to men [4,28,29].…”

Section: Study Descriptionmentioning

confidence: 99%

“…Leukemia relapse will not be observed once patients have died. Similarly, in a study of people with diabetes, end-stage renal disease (ESRD) and death compete for the life of the person, and each influence the risk of the other [3,4]. When a person experiences an event other than the one of interest in the study, the probability of experiencing the event of interest is frequently altered.…”

Section: Introductionmentioning

confidence: 99%

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Methods of competing risks analysis of end-stage renal disease and mortality among people with diabetes

Lim

Zhang

Dyck

et al. 2010

BMC Med Res Methodol

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BackgroundWhen a patient experiences an event other than the one of interest in the study, usually the probability of experiencing the event of interest is altered. By contrast, disease-free survival time analysis by standard methods, such as the Kaplan-Meier method and the standard Cox model, does not distinguish different causes in the presence of competing risks. Alternative approaches use the cumulative incidence estimator by the Cox models on cause-specific and on subdistribution hazards models. We applied cause-specific and subdistribution hazards models to a diabetes dataset with two competing risks (end-stage renal disease (ESRD) or death without ESRD) to measure the relative effects of covariates and cumulative incidence functions.ResultsIn this study, the cumulative incidence curve of the risk of ESRD by the cause-specific hazards model was revealed to be higher than the curves generated by the subdistribution hazards model. However, the cumulative incidence curves of risk of death without ESRD based on those three models were very similar.ConclusionsIn analysis of competing risk data, it is important to present both the results of the event of interest and the results of competing risks. We recommend using either the cause-specific hazards model or the subdistribution hazards model for a dominant risk. However, for a minor risk, we do not recommend the subdistribution hazards model and a cause-specific hazards model is more appropriate. Focusing the interpretation on one or a few causes and ignoring the other causes is always associated with a risk of overlooking important features which may influence our interpretation.

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“…One explanation has been that the death rates of some wait-listed subgroups (e.g. patients with peripheral vascular disease or diabetes [13,14]) increase with time on dialysis, whereas transplantation would lengthen their survival [15]. Although some survival studies of wait-listed dialysis patients versus kidney transplant recipients have expressed their results in projected years of life gained [5] or long-term hazard ratios for death [5,6], assessment of current graft allocation policies requires a comparison of the death rates according to ESRD duration.…”

Section: Introductionmentioning

confidence: 99%

Excess Risk of Death Increases with Time from First Dialysis for Patients on the Waiting List: Implications for Renal Allograft Allocation Policy

Bouaoun¹,

Villar

Écochard³

et al. 2013

Nephron Clin Pract

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Background: Subgroups of patients registered on a kidney transplant waiting list have higher than usual mortality levels. This study used data from the French Renal Epidemiology and Information Network (REIN) Registry to quantify the impact over time of various comorbidities on the excess risk of death among patients on the waiting list. Methods: Lexis diagrams were used to analyze time since onset of end-stage renal disease and time since registration on the waiting list. The number of excess deaths was calculated by comparison with the number of expected deaths in the general population of the same age and sex. Results: During 45,013 person-years of follow-up, 7,224 patients died, 5,956 (82%) more than expected relative to the general population. There were 101 deaths among wait-listed dialysis patients, 76 more than expected. The excess risk of death increased by 45% per additional year on the waiting list (18-79%, p = 0.0005). Time from end-stage renal disease onset until list registration (p = 0.004), time since registration (p < 0.001), age >65 years (p = 0.008), the presence of a primary renal disease (p = 0.028), and the number of comorbidities (p = 0.035) were independent predictors of death while on the waiting list. Conclusions: The excess risk of death while on the waiting list increased faster in patients with comorbidities. These results require consideration of ways to accelerate access to transplantation in high-risk patients.

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The Impact of Type 2 Diabetes on Mortality in End-Stage Renal Disease Patients Differs between Genders

Cited by 22 publications

References 61 publications

Parathyroidectomy Is Associated with Reduced Mortality in Hemodialysis Patients with Secondary Hyperparathyroidism

Parathyroidectomy Is Associated with Reduced Mortality in Hemodialysis Patients with Secondary Hyperparathyroidism

Methods of competing risks analysis of end-stage renal disease and mortality among people with diabetes

Excess Risk of Death Increases with Time from First Dialysis for Patients on the Waiting List: Implications for Renal Allograft Allocation Policy

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