Bruno R M, Gross J L
Renal Division, Complexo Hospitalar Santa Casa de Porto Alegre, and Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, RS, Porto Alegre, Brazil.
J Diabetes Complications. 2000 Sep-Oct;14(5):266-71. doi: 10.1016/s1056-8727(00)00118-5.
The objective of this study was to analyze the prognostic factors of a cohort of diabetic patients starting dialysis. This prospective, 3. 6-year population-based cohort study included 111 diabetic patients starting dialysis in all 18 dialysis centers of the metropolitan area of Porto Alegre, Brazil, between July 1995 and October 1996. The survival rate was analyzed by Kaplan-Meier curves and prognostic factors for death by Cox's proportional-hazards model. During the study period, 685 patients started dialysis; 182 (26.5%) had diabetes and 111 patients were included. Eighty-four percent of the 111 patients were classified as type 2 diabetes (random C-peptide>0. 6 ng/ml), and these patients presented more coronary artery disease (60% vs. 29%; P<0.02) than type 1 patients. In type 2 patients, later diagnosis of diabetes was associated with a shorter interval until beginning of dialysis (r=0.67; P=0.001). Diabetic nephropathy was the primary renal disease in 61% of all patients. Overall median survival (26 months) was similar for types 1 and 2 diabetic patients. Survival in the first, second, and third year was 69%, 51%, and 28%, respectively. Cardiovascular disease was the most common cause (63%) of death. According to Cox's proportional-hazards model, history of stroke (HR: 4.53, CI: 2.09-9.86, P<0.0001), amputations (HR: 3.2, CI: 1.61-6.35, P<0.0009), and coronary artery disease (HR: 1.67, CI: 0.95-2.96, P<0.076) at baseline were significantly associated with mortality. In conclusion, macrovascular complications were the main predictors of mortality in this cohort of diabetic patients starting dialysis. Intensive treatment of cardiovascular risk factors during dialysis might reduce the mortality rate of diabetic patients.
本研究的目的是分析一组开始透析的糖尿病患者的预后因素。这项前瞻性、基于人群的3.6年队列研究纳入了1995年7月至1996年10月期间在巴西阿雷格里港大都市区所有18个透析中心开始透析的111例糖尿病患者。通过Kaplan-Meier曲线分析生存率，并通过Cox比例风险模型分析死亡的预后因素。在研究期间，685例患者开始透析；182例（26.5%）患有糖尿病，其中111例被纳入研究。111例患者中84%被分类为2型糖尿病（随机C肽>0.6 ng/ml），这些患者比1型患者出现更多的冠状动脉疾病（60%对29%；P<0.02）。在2型患者中，糖尿病的晚期诊断与开始透析前的间隔时间较短有关（r=0.67；P=0.001）。糖尿病肾病是所有患者中61%的主要肾脏疾病。1型和2型糖尿病患者的总体中位生存期（26个月）相似。第一年、第二年和第三年的生存率分别为69%、51%和28%。心血管疾病是最常见的死亡原因（63%）。根据Cox比例风险模型，基线时的中风病史（HR：4.53，CI：2.09-9.86，P<0.0001）、截肢（HR：3.2，CI：1.61-6.35，P<0.0009）和冠状动脉疾病（HR：1.67，CI：0.95-2.96，P<0.076）与死亡率显著相关。总之，大血管并发症是这组开始透析的糖尿病患者死亡率的主要预测因素。透析期间强化治疗心血管危险因素可能会降低糖尿病患者的死亡率。
