| ObjectiveDiabetes mellitus is the major cause of ESRD worldwide,contributing to an increasing risk of their death.A majority of ESRD patients with diabetes have received the treatment of hemodialysis.However,Clinical outcomes of HD patients with diabetes were much worse compared with those without diabetes.Our study aims to systematically evaluate the clinical prognosis and associated risk factors of mortality among HD patients with diabetes,as well as the impact of TCM within them.So as to provide reference and research ideas for optimizing the treatment plan among HD patients underlying diabetes in the southern China.MethodsThrough this retrospective cohort study,we analyzed data on clinical outcomes and laboratory indicators of adult HD patients who were classified as diabetes and non-diabetes from January 1st 2012 through December 31st 2017,at Guangdong Provincial Hospital of Chinese Medicine.Patients were followed from baseline until the clinical outcome or the date of December 31st,2018,whichever came first.The difference of survival outcomes between two groups were assessed by survival analysis.On multivariate Cox analysis,we compared information on demographic,laboratory indexes,coexisting conditions and therapy of TCM,whether there was a difference associated with death between two groups or not.Moreover,there was a further study analyzed the risk associated with mortality among diabetes HD patients in order to find out the related factors of mortality and if the TCM played roles in it.Results1.The study involved in 348 adult HD patients with a median of 34 months of dialysis duration,among 45.4%had diabetes.There was a statistically significant in syndrome of water dampness obstructed with blood stasis among diabetic HD patients,as compared with those without diabetes(P<0.001).2.Compared with non-diabetes group,there was a lower primary AVF patency rate in diabetes group along with downward trend,and then the 5-year primary AVF patency rate was 53.5%.3.The survival advantage was significantly lower in Diabetic patients than in Non-Diabetic patients(P=0.035)after adjusting for various confounders.HD patients who were older age or in male sex had a significantly elevated mortality,as did those with coexisting diabetes,CVD or higher hemoglobin.4.On multivariate Cox analysis,presence of CVD(HR 3.670,95%confidence interval 1.188-11.320),P=0.024)and excessive hemoglobin(HR 1.020,95%CI 1.000-1.040,P=0.045)were associated with greater risk of mortality while those with higher BMI(HR 0.440,95%CI 0.213-0.930,P=0.031)had a reduction risk of mortality.The use of Chinese Medicine(HR 0.710,95%CI 0.260-1.960,P=0.513)was correlated with decreased risk of death in diabetes HD patients,though the decline was not statistically significant.Conclusion1.The survival advantages and primary patency rate of AVF were significantly lower in diabetes patients than in non-diabetes patients.2.Aside from diabetes,coexisting of CVD and excessive hemoglobin predicted higher mortality while the higher BMI was associated with better survival.3.On this retrospective study,there was a reduction risk of mortality in the use of Chinese medicine among diabetes HD patients before and after dialysis,though the decline was not statistically significant.It also reflected the effect of TCM therapy,but it needed randomized prospective trial to identify the relationship. |
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