Vijayan Madhusudan, Radhakrishnan Saranya, Abraham Georgi, Mathew Milly, Sampathkumar Krishnaswamy, Mancha Nevin Philip
Kilpauk Medical College, Chennai, India.
Macaulay Honors College, New York, NY, USA.
Clin Kidney J. 2016 Dec;9(6):833-838. doi: 10.1093/ckj/sfw069. Epub 2016 Aug 17.
Diabetic kidney disease is the leading cause of stage 5 chronic kidney disease (CKD) in India. Renal replacement therapy (RRT) is accessible to very few patients because of socioeconomic deprivation. We studied the effect of diabetes and socioeconomic status on the outcome of patients on maintenance hemodialysis (MHD).
We retrospectively analyzed the outcome of 897 patients (629 males/268 females; mean age ± standard deviation 48.69 ± 14.27 years) initiated on MHD from 2003 to 2009 at five dialysis centers in south India. There were 335 type 2 diabetic patients and 562 non-diabetic patients. Group 1 comprised the self-paying patients (518 patients) and Group 2 included the TANKER Foundation charity dialysis patients (379 patients). We compared the 5-year survival rates of Group 1 versus Group 2 and also those of diabetic versus non-diabetic patients, using the Kaplan-Meier survival estimator.
Of the 897 patients, 166 patients survived, 350 died, 234 were lost to follow-up, 137 had renal transplantation and 10 patients were transferred to peritoneal dialysis. The 5-year survival rates after censoring were 20.7 and 38.2% for diabetic and non-diabetic patients, respectively (P < 0.001). The survival rate of diabetic patients was significantly lower, compared with non-diabetic patients, in Group 2 (P < 0.001), but not significantly lower in Group 1 (P = 0.226).
Diabetic patients have poor survival rates on MHD, especially those from poor socioeconomic groups. Due to scarce RRT facilities and poor survival rates of diabetic patients, prevention, early detection and management of diabetic CKD patients should be the way to go forward.
在印度，糖尿病肾病是导致5期慢性肾脏病（CKD）的主要原因。由于社会经济贫困，很少有患者能够接受肾脏替代治疗（RRT）。我们研究了糖尿病和社会经济状况对维持性血液透析（MHD）患者预后的影响。
我们回顾性分析了2003年至2009年在印度南部五个透析中心开始接受MHD治疗的897例患者（629例男性/268例女性；平均年龄±标准差48.69±14.27岁）的预后情况。其中有335例2型糖尿病患者和562例非糖尿病患者。第1组包括自费患者（518例），第2组包括TANKER基金会慈善透析患者（379例）。我们使用Kaplan-Meier生存估计器比较了第1组与第2组以及糖尿病患者与非糖尿病患者的5年生存率。
在这897例患者中，166例存活，350例死亡，234例失访，137例接受了肾移植，10例转为腹膜透析。经审查后，糖尿病患者和非糖尿病患者的5年生存率分别为20.7%和38.2%（P<0.001）。在第2组中，糖尿病患者的生存率明显低于非糖尿病患者（P<0.001），但在第1组中差异不显著（P=0.226）。
糖尿病患者接受MHD治疗的生存率较低，尤其是来自社会经济贫困群体的患者。由于RRT设施稀缺以及糖尿病患者生存率较低，预防、早期发现和管理糖尿病CKD患者应是未来的发展方向。
