Coronel Francisco, Cigarran Secundino, Herrero Jose Antonio
Nephrology Department, Hospital Clinico, San Carlos, Madrid, Spain.
Scand J Urol Nephrol. 2009;43(2):148-53. doi: 10.1080/00365590802602903.
Starting dialysis earlier in diabetic patients than in other patients with chronic kidney disease slows the progression of some diabetic complications, and could affect the survival outcome. The aim of this study is to assess the effect of starting dialysis early in diabetic patients on survival and hospitalization outcome.
One-hundred diabetic patients on peritoneal dialysis (PD), 54 with type 1 and 46 with type 2 diabetes, were reviewed. Renal function was estimated by Modification of Diet in Renal Disease-7 (MDRD-7). The patients comprised two groups according to average MDRD-7 (7.7 ml/min/1.73 m(2)): group I > 7.7 (56 patients) and group II < or = 7.7 (44 patients). Survival was analysed by Kaplan-Meier plots and Cox hazard regression for the different variables.
MDRD-7 values (mean+/-SD) at the start of PD were 10.6+/-2.1 in group I and 5.4+/-1.2 in group II (p<0.001). Serum albumin (p<0.001) and haematocrit values (p=0.013) were higher in group I, while glycosylated haemoglobin was higher in group II. Kaplan-Meier plots showed higher survival, at 3 years, in group I than in group II (61% vs 39%, p=0.007). In patients with type 2 diabetes there was also greater survival in patients who began PD early compared with later PD initiation. In univariate analysis cerebrovascular pathology had a major influence on survival (odds ratio 2.94, 95% confidence interval 1.3-6.3, p=0.006). Multivariate analysis showed that age and initial serum albumin, and comorbidities such as cerebrovascular disease and cardiac failure, were the factors with the greatest impact on survival.
Early initiation of peritoneal dialysis in diabetic patients seems to improve patient survival. Initial serum albumin and age, and the presence of cerebrovascular pathology and cardiac failure are critical factors affecting survival outcome.
糖尿病患者比其他慢性肾脏病患者更早开始透析可减缓某些糖尿病并发症的进展，并可能影响生存结局。本研究旨在评估糖尿病患者早期开始透析对生存和住院结局的影响。
回顾了100例接受腹膜透析（PD）的糖尿病患者，其中54例为1型糖尿病，46例为2型糖尿病。通过肾脏病饮食改良-7（MDRD-7）评估肾功能。根据平均MDRD-7（7.7 ml/min/1.73 m²）将患者分为两组：I组>MDRD-7（56例患者）和II组≤MDRD-7（44例患者）。通过Kaplan-Meier曲线和Cox风险回归分析不同变量的生存率。
PD开始时I组的MDRD-7值（均值±标准差）为10.6±2.1，II组为5.4±1.2（p<0.001）。I组的血清白蛋白（p<0.001）和血细胞比容值（p=0.013）较高，而II组的糖化血红蛋白较高。Kaplan-Meier曲线显示，I组3年生存率高于II组（61%对39%，p=0.007）。在2型糖尿病患者中，早期开始PD的患者生存率也高于晚期开始PD的患者。单因素分析显示脑血管病变对生存有重大影响（比值比2.94，95%置信区间1.3-6.3，p=0.006）。多因素分析显示年龄、初始血清白蛋白以及脑血管疾病和心力衰竭等合并症是对生存影响最大的因素。
糖尿病患者早期开始腹膜透析似乎可提高患者生存率。初始血清白蛋白、年龄以及脑血管病变和心力衰竭的存在是影响生存结局的关键因素。
