Retrospective Analysis The Risk Factors Of Hemodialysis For Diabetic Nephropathic Patients

Purpose:The object of this study was to compare the effectivity and safety of hemodialysis for both diabetic and nondiabetic end-stage renal disease patients, to observe whether there are risk factors for diabetic individuals, and give a suggestion of how to administrate diabetic patients during hemodialysis for clinicians.Method:A Retrospective study was carried out with 34 diabetic and 43 nondiabetic patients, all of them started and continued hemodialysis in our center from December 1st,2007 to October 1st,2010 were included. Collect information of patients' characteristics, assessments before the first dialysis, records of pre- and post-dialysis each time, complications during the follow-up period, and so on. All of the data was collected from the electronic system in our center. Chi-test was made to analyses difference between diabetic and nondiabetic patients for disaggregated data, while T-test for continuous data.Result:There are no differences of age, gender, and dialysis age between the two group. The diabetic nephropathic patients (DNs) significantly higher and heavier than the nondiabetic patients (nDNs), and the body mass index (BMI) had a higher trend as well(22.50±3.37kg/cm2 vs 21.37±2.94 kg/cm2). Before the first dialysis, there was a higher systolic blood pressure (SBP) in DNs (163.6±16.6mmHg vs 155.7±23.3mmHg, P=0.09), and SBP pre- and post-dialysis for each time were also higher,161±17mmHg vs 148±14mmHg and 155±16mmHg vs 144±14mmHg,respectively. DNs started dialysis in lower serum creatinine, blood urea nitrogen, parathyroid hormone, and albumin, P value of the differences are all less than 0.05. However, the cardiac function assessment had no difference between these two group, neither the left ventricle ejection fraction(LVEF), nor the left ventricle mass index(LVMI). There were 85.3% DNs and 72.1%nDNs had a disciplinary hemodialysis (>=3 time per week). Both the average dialysis duration were more than 3 hours, and the Kt/V were more than 1.4. Increasing body weight during dialysis interval was more for DNs (3.62%±0.88% vs 2.25%±1.22%, P<0.000001). During our limited observation (612±297d vs 565±272d), the over-survival was similar for the two groups. However, the complication risks were higher in individuals with diabetes, especially cardiovascular and cerebrovascular events, as well as infections.Conclusion:Hemodialysis is a feasible renal replacement therapy for end-stage diabetic nephropathy patients, and these patients usually have a lot of co-morbidities and complications, and need to dialysis in earlier stage. These patients have a higher risk than nondiabetic individuals, due to the poor health basis and the extensive vascular lesions of the whole body. The clinicians should pay more attention on the blood pressure, body weight control and administrate complications as early as possible.