Abysmal prognosis of patients with type 2 diabetes entering dialysis
| Autor: | Bruno Moulin, Thierry Hannedouche, François Chantrel, Kolb I, Bouiller M, Kristian Kunz, I Enache, P. Petitjean |
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| Rok vydání: | 1999 |
| Předmět: |
Nephrology
Male medicine.medical_specialty Time Factors medicine.medical_treatment Renal function Blood Pressure Type 2 diabetes Nephropathy Renal Dialysis Diabetes mellitus Internal medicine medicine Prevalence Humans Diabetic Nephropathies Intensive care medicine Dialysis Aged Retrospective Studies Transplantation business.industry Acute Kidney Injury Middle Aged medicine.disease Prognosis Survival Analysis Treatment Outcome Diabetes Mellitus Type 2 Cardiovascular Diseases Kidney Failure Chronic Female Hemodialysis business Diabetic Angiopathies Kidney disease Follow-Up Studies |
| Zdroj: | Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 14(1) |
| ISSN: | 0931-0509 |
| Popis: | 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. Material 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 longstanding diabetes (mean duration ∼15 years), heavy proteinuria (∼3g/24h) and diabetic retinopathy (67%). 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. Conclusion. Our observational study illustrates the high burden of cardiovascular diseases contrasting 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. |
| Databáze: | OpenAIRE |
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