Nephrology Dialysis Transplantation, Vol 14, Issue 1 129-136, Copyright © 1999 by Oxford University Press
F Chantrel, I Enache, M Bouiller, I Kolb, K Kunz, P Petitjean, B Moulin and T Hannedouche
Introduction: The importance of non-insulin-dependent
diabetes mellitus (type II diabetes) as a leading cause of end-stage renal
disease is now widely recognized. The purpose of this study was to assess
life-prognosis and its predictors in a cohort of patients newly entering
dialysis. Materials and methods: Eighty-four
consecutive type II diabetes patients (40% of all patients) starting
dialysis between 01/01/95 and 31/12/96 were studied retrospectively,
focusing on clinical data at inception and life-prognosis after a mean
follow-up of 211 days. Patients were divided into three groups, according
to onset of renal failure: acute 11% (9/84), chronic 61% (51/84) and
acutely aggravated chronic renal failure 28% (25/84).
Results: Patients (mean age 67 years) had
long-standing diabetes (mean duration 15 years), heavy proteinuria ( 3
g/24 h) and diabetic retinopathy (667%). The average creatinine clearance
(Cockcroft's formula) was 13 ml/min. Cardiovascular diseases were highly
prevalent at the start of dialysis: history of myocardial infarction (26%),
angina (36%) and acute left ventricular dysfunction (67%). More than 80% of
the patients underwent the first session dialysis under emergency
conditions, a situation in part related to late referral to the nephrology
division (63% for chronic patients). A great majority of the patients were
overhydrated when starting dialysis, as evidenced by the average weight
loss of 6 kg, during the first month of dialysis, required to reach dry
weight. Nearly 64% of the patients presented high blood pressure
(>140/90 mmHg) when starting dialysis despite antihypertensive
therapy (mean: 2.3 drugs). The outcome of this type II diabetes population
was dramatic: 32% (27/84) died after a mean follow-up of 211 days, mostly
from cardiovascular diseases. The rate of recovery of renal function was
low in both the acute and the acutely aggravated renal failure group (30%
and 24%, respectively). Of note, iatrogenic nephrotoxic agents accounted
for renal function impairment in nearly 30% of patients.
Conclusions: Our observational study illustrates the
high burden of cardiovascular diseases constraint with sub-optimal
cardiovascular therapeutic interventions in type II diabetes patients
entering dialysis. Factors aggravating renal failure were mainly
iatrogenic, and therefore largely avoidable. Late referral generally
implied a poor clinical condition at the start of dialysis. Key
words: acute renal failure; chronic renal failure; diabetes;
diabetic nephropathy; dialysis; mortality; type II diabetes
ORIGINAL ARTICLES
Abysmal prognosis of patients with type 2 diabetes entering dialysis
Service de Nephrologie & Hemodialyse, Hopitaux Universitaires de Strasbourg, PO Box 426, F-67000 Strasbourg, France; Corresponding author
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  C. Abaterusso, A. Lupo, V. Ortalda, V. De Biase, A. Pani, M. Muggeo, and G. Gambaro Treating Elderly People with Diabetes and Stages 3 and 4 Chronic Kidney Disease Clin. J. Am. Soc. Nephrol., July 1, 2008; 3(4): 1185 - 1194. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. H. W. Gowdak, F. J. de Paula, L. A. M. Cesar, E. E. M. Filho, L. E. Ianhez, E. M. Krieger, J. A. F. Ramires, and J. J. G. De Lima Diabetes and coronary artery disease impose similar cardiovascular morbidity and mortality on renal transplant candidates Nephrol. Dial. Transplant., May 1, 2007; 22(5): 1456 - 1461. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Raffaitin, C. Lasseur, P. Chauveau, N. Barthe, H. Gin, C. Combe, and V. Rigalleau Nutritional status in patients with diabetes and chronic kidney disease: a prospective study Am. J. Clinical Nutrition, January 1, 2007; 85(1): 96 - 101. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. J. Craig, J. D. Williams, S. G. Riley, H. Smith, D. R. Owens, D. Worthing, I. Cavill, and A. O. Phillips Anemia and Diabetes in the Absence of Nephropathy Diabetes Care, May 1, 2005; 28(5): 1118 - 1123. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Rigalleau, C. Lasseur, C. Perlemoine, N. Barthe, C. Raffaitin, C. Liu, P. Chauveau, L. Baillet-Blanco, M.-C. Beauvieux, C. Combe, et al. Estimation of Glomerular Filtration Rate in Diabetic Subjects: Cockcroft formula or Modification of Diet in Renal Disease study equation? Diabetes Care, April 1, 2005; 28(4): 838 - 843. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Schiel, S. Heinrich, T. Steiner, U. Ott, and G. Stein Long-term prognosis of patients after kidney transplantation: a comparison of those with or without diabetes mellitus Nephrol. Dial. Transplant., March 1, 2005; 20(3): 611 - 617. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. M. Curtis, P. Ravani, F. Malberti, F. Kennett, P. A. Taylor, O. Djurdjev, and A. Levin The short- and long-term impact of multi-disciplinary clinics in addition to standard nephrology care on patient outcomes Nephrol. Dial. Transplant., January 1, 2005; 20(1): 147 - 154. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. J. Craig, K. Donovan, M. Munnery, D. R. Owens, J. D. Williams, and A. O. Phillips Identification and Management of Diabetic Nephropathy in the Diabetes Clinic Diabetes Care, June 1, 2003; 26(6): 1806 - 1811. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Boucek, F. Saudek, E. Pokorna, S. Vitko, M. Adamec, R. Koznarova, and V. Lanska Kidney transplantation in type 2 diabetic patients: a comparison with matched non-diabetic subjects Nephrol. Dial. Transplant., September 1, 2002; 17(9): 1678 - 1683. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S.-M. Herrmann, J. Ringel, J.-G. Wang, J. A. Staessen, and E. Brand Peroxisome Proliferator-Activated Receptor-{gamma}2 Polymorphism Pro12Ala Is Associated With Nephropathy in Type 2 Diabetes: The Berlin Diabetes Mellitus (BeDiaM) Study Diabetes, August 1, 2002; 51(8): 2653 - 2657. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Joss, K. R Paterson, C. J Deighan, K. Simpson, and J M. Boulton-Jones Vascular disease and survival in patients with type 2 diabetes and nephropathy The British Journal of Diabetes & Vascular Disease, March 1, 2002; 2(2): 137 - 142. [Abstract] [PDF]
|
|
|
|
|
|
M. Espinosa, A. Martin-Malo, M. A. A. de Lara, and P. Aljama Risk of death and liver cirrhosis in anti-HCV-positive long-term haemodialysis patients Nephrol. Dial. Transplant., August 1, 2001; 16(8): 1669 - 1674. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. V. Mieghem, C. Fonck, W. Coosemans, B. Vandeleene, Y. Vanrenterghem, J.-P. Squifflet, and Y. Pirson Outcome of cadaver kidney transplantation in 23 patients with type 2 diabetes mellitus Nephrol. Dial. Transplant., August 1, 2001; 16(8): 1686 - 1691. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. J. G. De Lima, M. L. C. Vieira, H. Abensur, and E. M. Krieger Baseline blood pressure and other variables influencing survival on haemodialysis of patients without overt cardiovascular disease Nephrol. Dial. Transplant., April 1, 2001; 16(4): 793 - 797. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Giordano, D. Manzella, G. Paolisso, A. Caliendo, M. Varricchio, and C. Giordano Differences in heart rate variability parameters during the post-dialytic period in type II diabetic and non-diabetic ESRD patients Nephrol. Dial. Transplant., March 1, 2001; 16(3): 566 - 573. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Passadakis, E. Thodis, V. Vargemezis, D. Oreopoulos, F. Chantrel, B. Moulin, and T. Hannedouche Abysmal prognosis with type 2 diabetes entering dialysis Nephrol. Dial. Transplant., August 1, 2000; 15(8): 1257 - 1258. [Full Text] [PDF]
|
|
|
|
 |
|
 E. Ritz and S. R. Orth Nephropathy in Patients with Type 2 Diabetes Mellitus N. Engl. J. Med., October 7, 1999; 341(15): 1127 - 1133. [Full Text] [PDF]
|
|
|
|
|
|
D. J. Cordonnier, S. Halimi, and P. Zaoui Survival comparisons in haemodialysis between France and USA. Nephrol. Dial. Transplant., October 1, 1999; 14(10): 2519 - 2520. [Full Text] [PDF]
|
|
|
|
|
|
J. Guiserix Survival comparisons in haemodialysis between France and USA Nephrol. Dial. Transplant., October 1, 1999; 14(10): 2519a - 2520a. [Full Text] [PDF]
|
|