Survival Rate Of Diabetic Kidney Disease Patients On Hemodialysis And Its Influencing Factors

Objective: Diabetic kidney disease(DKD)is one of the primary diseases in hemodialysis population.In recent years,the number of DKD hemodialysis patients has increased significantly.DKD patients have many complications and complicated clinical characteristics,and often have a poor survival prognosis.This paper will explore the survival rate of DKD hemodialysis patients and analyze the related risk factors affecting the survival and prognosis of patients.Methods: Patients who received hemodialysis treatment in the Hemodialysis Center of The Affiliated Hospital of Yan ’an University from January 1,2014 to December 31,2018 and met the inclusion criteria were included in the study.The basic data of all patients were collected as follows: primary kidney disease,age of first dialysis,gender,age of dialysis,blood pressure,body mass index(BMI),complications,type of vascular access,etc.Laboratory indicators: Albumin(ALB),prealbumin(PA),hemoglobin(HB),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),blood creatinine(SCr),blood urea nitrogen(BUN),blood potassium(K),blood sodium(Na),blood calcium(Ca),and blood phosphorus(P),serum uric acid(UA),whole parathyroid hormone(i PTH),fasting blood glucose(FBG).The subjects were divided into DKD group and non-DKD group according to whether the primary disease was DKD.Patients in both groups were followed up until December 31,2021 to observe the outcome of the two groups,and the end event was death.Patients who underwent kidney transplantation,changed to peritoneal dialysis,were transferred out,gave up treatment,and were still alive at the end of the follow-up were defined as deleted cases.The specific time of deletion case withdrawal and the specific time and cause of endpoint events were recorded during follow-up.SPSS22.0 statistical software was used for statistical analysis.Kaplan-meier survival curve analysis was used for survival analysis,and COX regression was used to analyze the risk factors for survival.Results:(1)A total of 187 patients were enrolled,including 117 cases of chronic nephritis syndrome(62.6%),53 cases of DKD(28.3%),3 cases of polycystic kidney disease(1.6%),3 cases of hypertensive nephropathy(1.6%),1 case of obstructive nephropathy(1.1%),and 9 cases of others(4.8%).(2)There were 53 patients(28.34%)in the DKD group and 134 patients(71.66%)in the non-DKD group.The results showed that the age and SBP of the DKD group were higher than those of the Non-DKD group(P <0.05).Biochemical indexes showed that HB,ALB,PA and Ca in DKD group were lower than those in non-DKD group(P<0.05),while TG,LDL-C,P and FBG were higher than those in Non-DKD group(P<0.05).Comparison of complications and mortality:PATIENTS in DKD group were more likely to develop CVD,infection and uremic encephalopathy than those in non-DKD group(P<0.05).The mortality rate caused by cardiovascular accident,cerebrovascular accident and infection in DKD group was significantly higher than that in non-DKD group(P<0.05).(3)Survival rate: the 1-year and3-year survival rates of all subjects were 96.5% and 77.4%,respectively;The survival rate of DKD group was lower than that of non-DKD group(log-rank =11.55,P=0.001).The 1-year and 3-year survival rates in DKD group were 94.0% and 64.5%,respectively.The 1-year and 3-year survival rates in non-DKD group were 97.5% and 82.9%,respectively.(4)Multivariate COX regression analysis of DKD patients showed that P(HR=3.037,95%CI=1.515-6.087;P=0.002),FBG(HR=1.068,95%CI=1.001-1.139;P=0.047)and concurrent CVD(HR=3.352,95%CI=1230-9.135;P=0.018)significantly affected the survival and prognosis of DKD hemodialysis patients.Conclusions:1.DKD is the second most common primary disease in hemodialysis patients in our hospital.2.The survival rate of DKD patients was lower than that of non-DKD patients.P,FBG and complicated CVD have influence on the survival and prognosis of DKD hemodialysis patients.