Abstract: TH-PO741

Impact of Type 2 Diabetes Mellitus (T2DM) with or without Diabetic Nephropathy (DN) on Long-Term Outcomes in ESKD Patients Initiated on Dialysis

Session Information

Category: Diabetes

  • 502 Diabetes Mellitus and Obesity: Clinical

Authors

  • Lim, Wai Hon, Sir Charles Gairdner Hospital, Perth, New South Wales, Australia
  • Johnson, David W., Princess Alexandra Hospital, Brisbane, Queensland, Australia
  • Polkinghorne, Kevan, Monash Medical Centre and Monash University, Melbourne, Victoria, Australia
  • Hawley, Carmel M., Princess Alexandra Hospital, Brisbane, Queensland, Australia
  • Lok, Charmaine E., Toronto General Hospital, Toronto, Ontario, Canada
  • Wong, Germaine, None, Auambie, New South Wales, Australia
Background

DN is the most common cause of ESKD among patients with T2DM, however there is growing evidence that T2DM patients with non-DN as a cause of ESKD form a distinct clinical entity with differential prognostic significance

Methods

All incident ESKD patients initiated on hemodialysis/peritoneal dialysis in Australia and New Zealand between 1980-2014 were included, using data from the ANZDATA Registry. The association between diabetes status at dialysis initiation (i.e. no diabetes, T2DM+DN or T2DM+non-DN) and mortality were examined using Cox regression and competing risk analyses, with transplantation censored or considered as competing risk, respectively

Results

Of 56,552 incident dialysis patients followed for a median of 2.5 years, 15,829 (28%) and 4993 (9%) had T2DM+DN and T2DM+non-DN, respectively. Patients with T2DM were significantly older and a greater proportion had vascular comorbidities. Compared to patients with no diabetes, the adjusted HR (95%CI) for mortality in those with T2DM+DN and T2DM+non-DN were 1.39 (1.35-1.43) and 1.24 (1.29-1.29) in the Cox regression model, and the adjusted subdistribution HR were 1.52 (1.47-1.56) and 1.32 (1.27-1.38), respectively in the competing risk model. There was a significant interaction (p<0.001) between age and diabetes status, with the hazard for mortality greater in younger compared to older patients. Cardiovascular disease as a cause of mortality was more common in patients with T2DM compared to no diabetes (43% vs. 34%, p<0.001). Kaplan Meier survival curves for mortality stratified by age categories are shown below

Conclusion

Younger ESKD diabetic patients with or without DN experienced substantially poorer survival compared to non-diabetic patients. A vigilant approach to CVD prevention and monitoring is critical to improve clinical outcomes in diabetic patients with ESKD