Abstract
BackgroundDiabetes is associated with development of end-stage renal disease (ESRD) dialysis, but it is not clear whether ESRD dialysis is a risk factor for new-onset diabetes (NODM).MethodsUsing the Taiwan National Health Insurance Research Database, we designed two cohort studies to determine the association between dialysis and diabetes. Analysis 1 estimated the hazard ratios (HR) of ESRD dialysis in 20,585 patients with type 2 diabetes (T2DM) and 82,340 gender- and age- matched controls without diabetes. Analysis 2 estimated the HRs of NODM in 18,489 ESRD patients undergoing dialysis and 73,956 gender- and age- matched controls without ESRD dialysis. The follow-up period was from 2000 to date of endpoint, the date of death, or December 31, 2008. Cox proportional models were used to estimate the relative hazards.ResultsIn analysis 1, the incidence of ESRD dialysis was higher in the T2DM cohort than in the non-diabetes cohort (6.78 vs. 0.61 per 1,000 person-years; HR: 7.97; 95%CI: 7.05–8.00). In analysis 2, the incidence of NODM was higher in the ESRD dialysis cohort than in the without-ESRD dialysis cohort (22.84 vs. 13.99 per 1,000 person-years; HR: 1.40; 95% CI: 1.34–1.47).ConclusionsESRD dialysis and diabetes were bidirectionally associated. The relationship between T2DM and incident ESRD dialysis was much stronger than between ESRD dialysis and NODM. Further studies are needed to determine the mechanism of ESRD dialysis-related NODM.
Highlights
End-stage renal disease (ESRD) is an important complication of diabetes (DM) [1]
In analysis 1, the incidence of ESRD dialysis was higher in the type 2 diabetes (T2DM) cohort than in the nondiabetes cohort (6.78 vs. 0.61 per 1,000 person-years; hazard ratios (HR): 7.97; 95%CI: 7.05–8.00)
In analysis 2, the incidence of new-onset diabetes mellitus (NODM) was higher in the ESRD dialysis cohort than in the withoutESRD dialysis cohort (22.84 vs. 13.99 per 1,000 person-years; HR: 1.40; 95% CI: 1.34–1.47)
Summary
End-stage renal disease (ESRD) is an important complication of diabetes (DM) [1]. Many studies report an association between pre-existing DM at the initiation of dialysis and a poor outcome in ESRD patients undergoing dialysis [1, 2]. New-onset diabetes mellitus (NODM) after the initiation of dialysis has been reported in some studies [3,4,5,6]. According to the U.S Center for Disease Control [7], the incidence rate for DM in the general population in the U.S fluctuated about 0.5–0.9% per year from 2000– 2009. A recent study [4] that used Taiwan‘s national health insurance claims for ESRD dialysis patients found the cumulative incidence rate of NODM to be 4% at one year, 9% at three years, and 14% at five years. Diabetes is associated with development of end-stage renal disease (ESRD) dialysis, but it is not clear whether ESRD dialysis is a risk factor for new-onset diabetes (NODM)
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