Catalano C, Postorino M, Marino C
Istituto di Fisiologia, Clinica del CNR, Unità di Metabolismo, via Savi, 8, 56100 Pisa, Italy.
Nephrol Dial Transplant. 1996 Jun;11(6):1124-8.
It is well known that dialysis patients with diabetic nephropathy have a poor prognosis, but data concerning the survival of dialysis patients with diabetes plus a non-diabetic primary nephropathy or the survival of patients who develop diabetes after the start of regular dialysis are scarce.
We reviewed the survival of two cohorts of dialysis patients in whom diabetes mellitus was associated with non-diabetic primary nephropathy. In the first cohort (18 patients with a primary diagnosis of APKD) diabetes mellitus precede hyperazotaemia, whilst the second cohort of 34 patients developed diabetes after the start of regular dialysis. We compared the survival of each group of patients to the survival of a group of dialysis patients with a primary diagnosis of diabetic nephropathy, and to the survival of each control group of non-diabetic dialysis patients. Within each case series, groups were similar according to age at start of RRT, and place of treatment. All patients were selected among those alive in treatment at 31 December 1986 and were followed up to 31 December 1991.
In both case series the survival of patients with diabetes was similar irrespective of the primary diagnosis (Lee-Desu statistics: first cohort P=0.43; second cohort, P=0.08). Moreover, the survival of patients either with diabetic nephropathy or with diabetes in association with non-diabetic primary nephropathy was significantly worse compared to the survival of the non-diabetic patients (Lee-Desu statistics: first case series P=0.02 and P<0.01; second case series P<0.05 and P<0.01). Logistic regression showed that survival was negatively associated to diabetes and age but not to sex, duration of diabetes and diagnosis of diabetic nephropathy.
Our limited data show that the survival of diabetic patients on regular dialysis is poor, irrespective of the primary cause of renal failure and of the duration of diabetes. These data need confirmation and further study.
众所周知，糖尿病肾病透析患者预后较差，但关于糖尿病合并非糖尿病原发性肾病的透析患者生存率，或开始规律透析后发生糖尿病患者的生存率的数据却很匮乏。
我们回顾了两组糖尿病与非糖尿病原发性肾病相关的透析患者的生存率。在第一组（18例原发性诊断为常染色体显性多囊肾病的患者）中，糖尿病先于高氮质血症出现，而第二组34例患者在开始规律透析后发生糖尿病。我们将每组患者的生存率与原发性诊断为糖尿病肾病的透析患者组的生存率进行比较，并与非糖尿病透析患者的每个对照组的生存率进行比较。在每个病例系列中，根据开始肾脏替代治疗时的年龄和治疗地点，各小组情况相似。所有患者均选自1986年12月31日仍在接受治疗的患者，并随访至1991年12月31日。
在两个病例系列中，无论原发性诊断如何，糖尿病患者的生存率相似（Lee-Desu统计：第一组P=0.43；第二组，P=0.08）。此外，与非糖尿病患者的生存率相比，糖尿病肾病患者或糖尿病合并非糖尿病原发性肾病患者的生存率明显更差（Lee-Desu统计：第一个病例系列P=0.02和P<0.01；第二个病例系列P<0.05和P<0.01）。逻辑回归显示，生存率与糖尿病和年龄呈负相关，但与性别、糖尿病病程和糖尿病肾病诊断无关。
我们有限的数据表明，无论肾衰竭的主要原因和糖尿病病程如何，接受规律透析的糖尿病患者生存率较差。这些数据需要进一步证实和研究。
