Tamami Shino

Predialysis factors related to prognosis in type 2 diabetic patients on chronic dialysis in Japan

SUMMARY: We investigated to clarify the predialysis factors associated with prognosis in type 2 diabetic patients entering chronic dialysis. One hundred and twenty‐four type 2 diabetic patients who started chronic dialysis in our department between January 1992 and November 2000 were studied. the variables in the predialysis period and those at initiation of dialysis were collected and evaluated in association with prognosis after a mean follow up of 37 ± 23 months from initiation of dialysis by using Coxs proportional‐hazards model. the 1‐, 3‐, and 5‐year survival rates after initiating chronic dialysis were 92.7, 74.6, and 56.5%, respectively. During follow up, 40 patients died. Univariate analysis demonstrated that serum albumin (Alb) levels, haemoglobin A1c, and no preparation for permanent vascular or peritoneal access at initiation of dialysis were significantly associated with prognosis. In multivariate analysis, Alb levels (hazard ratio, 2.09, per decrease of 1 g/dL; confidence interval, 1.05–4.19), and age (1.54, per decrease of 10 years; 1.06–2.22) at initiation of dialysis remained significant predictors of mortality. In conclusion, Alb levels and age at initiation of dialysis are associated with prognosis in type 2 diabetic patients on chronic dialysis. It should be elucidated whether improvement of Alb levels at initiation of dialysis would have a favourable influence on survival after diabetic patients with renal failure are entered into chronic dialysis.