Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Cardiovasc Diabetol. 2021 Sep 8;20(1):179. doi: 10.1186/s12933-021-01364-w.
Type 2 diabetes mellitus is common in patients undergoing dialysis. However, the association between anti-diabetic drug use and survival outcomes is rarely discussed. We aimed to investigate whether continued anti-diabetic medication use affects the survival of diabetic dialysis patients and whether different hypoglycemic drug use influences prognosis.
Using a nationwide database, we enrolled patients with incident end-stage renal disease under maintenance dialysis during 2011-2015 into the pre-existing diabetes dialysis (PDD), incident diabetes after dialysis (IDD), and non-diabetic dialysis (NDD) groups. The PDD group was further subclassified into patients who continued (PDD-M) and discontinued (PDD-NM) anti-diabetic drug use after dialysis.
A total of 5249 dialysis patients were examined. The PDD-NM group displayed a significantly higher mortality rate than the IDD, PDD-M, and NDD groups (log-rank test P < 0.001). The PDD-M group had a significantly lower risk of death, regardless of insulin (P < 0.001) or oral hypoglycemic agent (OHA) (P < 0.001) use. Initial insulin administration or OHA had no statistically significant effect on overall mortality in the IDD group. But OHA use had better survival trends than insulin administration for the older (P = 0.02) and male subgroups (P = 0.05).
For dialysis patients with diabetes, continuous administration of anti-diabetic drugs after dialysis and choice of medication may affect outcomes.
2 型糖尿病在接受透析的患者中很常见。然而，抗糖尿病药物的使用与生存结果之间的关系很少被讨论。我们旨在研究抗糖尿病药物的持续使用是否会影响糖尿病透析患者的生存，以及不同的降血糖药物使用是否会影响预后。
我们使用一个全国性数据库，将 2011 年至 2015 年期间接受维持性透析的新发终末期肾病患者纳入预存糖尿病透析（PDD）、透析后新发糖尿病（IDD）和非糖尿病透析（NDD）组。PDD 组进一步分为透析后继续（PDD-M）和停止（PDD-NM）使用抗糖尿病药物的患者。
共检查了 5249 名透析患者。PDD-NM 组的死亡率明显高于 IDD、PDD-M 和 NDD 组（对数秩检验 P<0.001）。无论使用胰岛素（P<0.001）还是口服降糖药（OHA）（P<0.001），PDD-M 组的死亡风险均显著降低。初始胰岛素治疗或 OHA 对 IDD 组的总体死亡率没有统计学上的显著影响。但对于年龄较大（P=0.02）和男性亚组（P=0.05），OHA 治疗的生存趋势优于胰岛素治疗。
对于糖尿病透析患者，透析后持续使用抗糖尿病药物和药物选择可能会影响结果。
