Mortality difference by dialysis modality among new ESRD patients with and without diabetes mellitus

Background. In many parts of the world, diabetic nephropathy is the principal cause of patients requiring renal replacement therapy. The survival rate of diabetic patients on maintenance dialysis, either hemodialysis (HD) or peritoneal dialysis (PD), is lower than that of non-diabetic patients on either modality. However, studies analyzing the rates of survival between the methods have reported conflicting results. Methods. We used a retrospective analysis of data obtained from the China Medical University Hospital in Taiwan. All new endstage renal disease (ESRD) patients who were undergoing initial dialysis, either HD or PD, for more than 3 months at our hospital from January 2000 through December 2003, and were followed-up through June 2004, were included. We compared survival rates between diabetic and non-diabetic patients, and between the 2 modalities. Results. Of the 445 patients studied, 219 patients (49.2%) received HD and 226 patients (50.8%) received PD as their initial therapy. One hundred two HD patients (46.6%) and 96 PD patients (42.5%) were diabetic. The average age was 60±13 years for the HD patient group and 57±16 years for the PD patient group. The hemoglobin level for the HD group was 9.5±1.4 g/dL and 9.4±1.3 g/dL for the PD group. The serum albumin level was 3.0±0.6 g/dL for the HD group and 2.9±0.6 g/dL for the PD group. There was no significant difference in the number of co-morbidities between the HD and PD patients. Kaplan-Meier survival curve and Cox-regression analysis were used to compare the relative ratio (RR) of mortality between the HD and PD patient groups. Among these 445 patients, PD patients were associated with a significantly lower risk of death (RR: 0.382) compared with the HD patients. Older age (≥65 years), diabetes mellitus as the cause of ESRD, co-morbidity of ischemic heart disease, congestive heart failure, cerebral vascular accident, peripheral artery occlusive disease, or liver cirrhosis, and Hb levels <8.0 g/dL) and serum albumin levels <2.8 g/dL were associated with a significantly high risk of mortality. Conclusion. We found that new ESRD patients initiated treatment using PD had a higher survival rate than did those patients who chose to initate with HD. Additionally, non-diabetic patients had a higher survival rate than did diabetic patients. More than 2 co-morbidities, Hb level <8.0 g/dL), and serum albumin level <2.8 g/dL had a significantly high mortality rate in dialysis patients.