OUTCOME OF RENAL REPLACEMENT TREATMENT IN PATIENTS WITH DIABETES-MELLITUS

Objective - To compare the outcome of renal replacement treatment in patients with diabetes mellitus and in non-diabetic patients with end stage renal failure. Design - Retrospective comparison of cases and matched controls. Setting - Renal unit, Western Infirmary, Glasgow, providing both dialysis and renal transplantation. Patients - 82 Diabetic patients starting renal replacement treatment between 1979 and 1988, compared with 82 matched non-diabetic controls with renal failure and 39 different matched controls undergoing renal transplantation. Main outcome measures - Patient characteristics, history of smoking, prevalence of left ventricular hypertrophy and myocardial ischaemia at start of renal replacement treatment; survival of patients with renal replacement treatment and of patients and allografts with renal transplantation. Results - The overall survival of the diabetic patients during the treatment was 83%, 59%, and 50% at one, three, and five years. Survival was significantly poorer in the diabetic patients than the controls (p<0.001). Particularly adverse features for outcome at the start of treatment were increasing age (p<0.01) and current cigarette smoking (relative risk (95% confidence interval) 2.28 (0.93 to 4.84), p<0.05). Deaths were mainly from cardiac and vascular causes. The incidence of peritonitis in patients on continuous ambulatory peritoneal dialysis was the same in diabetic patients and controls (49% in each group remained free of peritonitis after one year), and the survival of renal allografts was not significantly worse in diabetic patients (p<0.5). Conclusions - Renal replacement treatment may give good results in diabetic patients, although the outlook remains less favourable than for non-diabetic patients because of coexistent, progressive vascular disease, which is more severe in older patients.