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

Abstract

The survival of diabetic patients on dialysis treatment is poor but variable. 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 patients with diabetic renal disease (biopsy proven or clinically suspected), who had commenced dialysis after 1980, were included in a retrospective survival 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 models using the S-plus statistical software package. According to our model, continued use of angiotensin-converting enzyme (ACE) inhibitor medication and renal replacement with peritoneal dialysis (PD) conferred a survival advantage. In addition, analysis of survival curves showed a significantly better outcome for insulin-dependent diabetic patients, patients on PD and those treated with ACE inhibitor medication. PD may have been associated with improved survival because of its preferential use in younger and fitter diabetic patients (mean age of PD patients at initiation of dialysis 50.3 years compared with 61.6 years for haemodialysis patients). Treatment with ACE inhibitor medication appears to be beneficial and should therefore be considered in all cases.