Different Risk Factors and Causes for Early Death after Initiating Dialysis in Diabetic and Non-Diabetic Patients

The mortality of patients with end-stage renal disease (ESRD) is especially high after the start of dialysis therapy, especially in diabetic patients. A part of these patients die within three months after initiating renal replacement therapy (RRT). In the present retrospective study we evaluated all patients with ESRD requiring RRT who died within 3 months after initiating the first RRT. A total of 42 patients who died such early after the start of dialysis treatment during the years 1995-2001 were included in the study. Of them, 28 subjects (age 66 + 11 years) were diabetics and 14 non-diabetics (age 76 + 10 years). Indications for the start of dialysis were end-stage renal failure (creatinine clearance < 10-12 mL/min or < 12-14 mL/min in diabetic patients) or fluid lung associated with chronic renal failure (creatinine clearance < 20 mL/min). Hyperhydration with fluid lung was the most common indication for dialysis therapy in patients with diabetes (64.3% versus 14.3%, p < 0.05). The vascular risk factors blood pressure and serum-lipids were similar in both groups; however, diabetic patients were younger than non-diabetic subjects. The prevalence of vascular diseases tended to be higher in the diabetic group, but difference was not significant (see Figure 1). Severe heart failure (NYHA stage III-IV) was more common among diabetics (42.8% versus 14.3%, p < 0.05). The incidence of sepsis (17.9% versus 14.3%) did not significantly differ between the groups. The most common cause of death was cardiovascular events in both diabetic and non-diabetic patients (71.5% and 64.2%, respectively). Heart failure was a more common cause of death in diabetic patients (39.2% versus 21.4%, NS). In conclusion, early death after the initiation of dialysis treatment was more common in patients with type 2 diabetes, though, the diabetic patients were less old. In the diabetic group fluid lung was more often indication for initiating dialysis therapy than in the non-diabetic group. In both, diabetic and non-diabetic patients, the most common causes of death are cardiovascular events.