Diabetic Dialysis Patients Research Articles

Study on the Clinical Application of Nutritional Management Combined with Clinical Monitoring of Glycated Albumin in Diabetic Nephropathy Dialysis Patients

Objective: To explore the clinical application of nutritional management combined with clinical monitoring of glycated albumin (GA) in diabetic nephropathy (DN) dialysis patients. Methods: A total of 20 diabetic nephropathy dialysis patients admitted to the People’s Hospital of Guandu District from January 2022 to February 2023 were included in the study. They were randomly divided into a conventional group (n = 10) and an observation group (n = 10). The study evaluated the blood glucose control, nutritional status, dialysis efficacy, and quality of life scores of both groups. Results: Before the intervention, there were no significant differences in fasting plasma glucose (FPG), GA, serum albumin, body mass index (BMI), dialysis efficiency values, urea clearance rate, or quality-of-life scores between the two groups (P > 0.05). After the intervention, the observation group showed significantly lower FPG and GA levels, higher serum albumin, dialysis efficiency values, urea clearance rate, and improved quality-of-life scores compared to the conventional group (P < 0.05), with no difference in BMI (P > 0.05). Conclusion: Nutritional management combined with clinical monitoring of glycated albumin has a significant effect on the clinical application of diabetic nephropathy dialysis patients. It can effectively improve patients’ blood glucose control and nutritional status, reduce the risk of complications, and enhance the quality of life, demonstrating clinical value for broader application.

A rare case of hepatic portal venous gas (HPVG) diagnosed as emphysematous cystitis in an elderly diabetic dialysis patient.

Hepatic portal venous gas (HPVG) is the presence of air bubbles in the portal vein and its branches. Traditionally it was considered a lethal condition because the main etiology was bowel ischemia. However, with the extensive use of diagnostic tools, it became clear that the causes of this condition are diverse and may include, but are not limited to, bowel necrosis. Here, we present a rare case of HPVG in an elderly dialysis patient with diabetes mellitus, initially diagnosed by ultrasound and CT scan. Our patient experienced abdominal pain, dysuria, oliguria, and other urinary symptoms starting three weeks prior. After considering all diagnostic tools and correlating them with the patient's history, clinical findings, and follow-up, the underlying cause of the HPVG was determined to be emphysematous cystitis. We concluded that the presence of HPVG in the initial screening test should prompt a comprehensive investigation to determine the cause, as a rare condition like emphysematous cystitis can result in HPVG.

#2833 Charlson comorbidity index predicts early failure and overall survival of vascular access among diabetic dialysis patients.

Abstract Background and Aims Vascular access (VA) survival is a determinant factor in the morbidity and mortality of haemodialysis patients, directly influencing their quality of life. Some studies have described the influence of diabetes on the reduced survival of arteriovenous fistulas as an independent factor; however, the correlation between other comorbidities in diabetic patients with vascular access survival has been less well documented. Therefore, our aim is to describe the relationship between comorbidities in diabetic haemodialysis patients and arteriovenous fistula (AVF) patency. Method Descriptive, observational and retrospective study in prevalent patients included in a haemodialysis programme by consulting electronic records over a period of 35 months. Demographic variables; related to vascular access and primary and secondary patency of all accesses were included. The Charlson Comorbidity Index was used to categorise diabetic patients according to comorbidities. Kaplan Meyer survival curves were used to contrast the impact of comorbidities on the different patency. Results 22 patients, mean age 68.36 ± 10.9 years, 68.18% male, 31.82% female, Charlson index with a median of 6.5 (5 - 8), 95.45% had a native fistula, with humero-cephalic location being more frequent (72.72%) and predominance of the left upper arm (68.18%). The time required to reach an event in both primary patency and secondary patency in diabetic patients was longer in patients with a Charlson index less than or equal to 7, this being statistically significant (Log Rank Test (Mantel-Cox): primary patency p=0.022 and secondary patency p=0.032). Conclusion The Charlson Comorbidity Index in our population is a significant factor in arteriovenous fistula survival.

Quality of Life of Dialysis Patients: Exploring the Influence of Membrane Hemocompatibility and Dialysis Practices on Psychosocial and Physical Symptoms

Hemodialysis (HD) is a life-sustaining membrane-based therapy that is essential for managing kidney failure. However, it can have significant physical and psychological effects on patients due to chronic or acute consequences related to membrane bioincompatibility. End-stage renal disease (ESRD) patients on hemodialysis have a high incidence of psychiatric illness, particularly depression and anxiety disorders, and poor quality of life has been observed. Dialysis can also lead to physical symptoms of its own, such as fatigue, loss of appetite, anemia, low blood pressure, and fluid overload, in addition to the symptoms associated with kidney failure. Therefore, this critical review aims to comprehensively understand the impact of dialysis membrane bioincompatibility and the use of varying molecular weight cut-off membranes on the physical and psychological symptoms experienced by dialysis patients. We analyzed the latest research on the correlation between major inflammatory biomarkers released in patients’ blood due to membrane incompatibility, as well as the critical influence of low levels of hemoglobin and vital proteins such as human serum albumin due to the use of high-cut-off membranes and correlated these factors with the physical and psychological symptoms experienced by dialysis patients. Furthermore, our study aims to provide valuable insights into the impact of dialysis on critical symptoms, higher hospitalization rates, and the quality of life of First Nations, as well as child and youth dialysis patients, in addition to diabetic dialysis patients. Our goal is to identify potential interventions aiming to optimize the dialysis membrane and minimize its negative effects on patients, ultimately improving their well-being and long-term outcomes.

Impact of preexisting coronary artery and peripheral artery disease on outcomes in diabetic patients after kidney transplant.

Atherosclerotic cardiovascular disease is highly prevalent in patients with end-stage kidney disease (ESKD). Kidney transplant (KT) improves patient survival and cardiovascular outcomes. The impact of preexisting coronary artery disease (CAD) and peripheral artery disease (PAD) on posttransplant outcomes remains unclear. This is a retrospective study utilizing the United States Renal Data System. Adult diabetic dialysis patients who underwent first KT between 2006 and 2017 were included. The study population was divided into four cohorts based on presence of CAD/PAD: (1) polyvascular disease (CAD + PAD); (2) CAD without PAD; (3) PAD without CAD; (4) no CAD or PAD (reference cohort). The primary outcome was 3-year all-cause mortality. Secondary outcomes were incidence of posttransplant myocardial infarction (MI), cerebrovascular accidents (CVA), and graft failure. The study population included 19,329 patients with 64.4% men, mean age 55.4 years, and median dialysis duration of 2.8 years. Atherosclerotic cardiovascular disease was present in 28% of patients. The median follow up was 3 years. All-cause mortality and incidence of posttransplant MI were higher with CAD and highest in patients with polyvascular disease. The cohort with polyvascular disease had twofold higher all-cause mortality (16.7%, adjusted hazard ratio (aHR) 1.5, p < 0.0001) and a fourfold higher incidence of MI (12.7%, aHR 3.3, p < 0.0001) compared to the reference cohort (8.0% and 3.1%, respectively). There was a higher incidence of posttransplant CVA in the cohort with PAD (3.4%, aHR 1.5, p = 0.01) compared to the reference cohort (2.0%). The cohorts had no difference in graft failure rates. Preexisting CAD and/or PAD result in worse posttransplant survival and cardiovascular outcomes in patients with diabetes mellitus and ESKD without a reduction in graft survival.

Visit-to-visit HbA1c variability is associated with poor prognosis in peritoneal dialysis patients with type 2 diabetes mellitus

BackgroundThe prognosis of diabetic peritoneal dialysis patients is poor. HbA1c serves as a crucial indicator for monitoring blood glucose control in patients with diabetes. Nevertheless, the relationship between visit-to-visit HbA1c variability and prognosis in peritoneal dialysis with diabetes remains unclear.MethodsAll participants were categorized into 3 groups based on the HbA1c variability score (HVS), which is the frequency of 0.5% (5.5 mmol/mol) alter in visit-to-visit HbA1c values. Then, the hazard ratio to HVS with all-cause mortality was analyzed using the Cox hazard model, followed by the Fine-Gray competing risk model for major adverse cardiovascular events. Subgroup and sensitivity analysis were conducted to ascertain the robustness of the findings.ResultsEight hundred twenty patients with type 2 diabetes were finally enrolled in this study from 2,855 participants with a mean age of 56.9 ± 14.6 years and a median follow-up time of 44 months [IQR: 27–70], death occurred in 496 (60.2%) individuals. Compared with the lowest category (HVS < 1/3) after being adjusted by potential confounding factors, the hazard ratio for all-cause mortality was 4.59 (3.74–5.64) and the sub-distribution hazard ratio for major adverse cardiovascular events was 1.91 (1.46–2.51) of the highest category (HVS ≥ 2/3). Subgroup interaction and sensitivity analysis, including the adjustment for variables such as time-weighted average HbA1c, HbA1c measurement times and expansion, confirmed the reliability of the results.ConclusionThe HVS is related to the risk of poor prognosis in peritoneal dialysis with type 2 diabetes mellitus, independently of clinical multiple variables, and is a novel indicator with clinical guidance.

Effects of Low-Impact Strengthening Exercises on Limb Pain and Strength in Diabetic Patients with End-Stage Renal Disease

Background: Diabetic nephropathy becomes a disease with a high mortality rate in this modern era of technology. Dialysis in diabetic patients affects kidney functioning is the most common treatment for end-stage renal failure but had different musculoskeletal complications due to bone mineral metabolisms like muscular cramping, atrophy and muscular weakness, restless leg syndrome and limb pain that lowers the quality of life and physical function. Objective: To evaluate the effects of low-impact strengthening exercises on limb pain, strength, glycemic control, hypertension and quality of life of patients with end-stage renal disease. Methods: The randomized controlled study was designed to check the effectiveness of low-impact strengthening exercises on patients involved in the treatment and control group. Using non-probability purposive sampling, data was collected from different hospitals in Faisalabad by providing treatment for six consecutive weeks. Outcomes of measures were pain, strength, glucose level, blood pressure and quality of life which were estimated through the numeric pain rating scale, manual muscle testing, glucometer, sphygmomanometer and kidney disease quality of life questionnaire respectively. Results: Low-impact strengthening exercises in the treatment group showed improvement in muscle strength, blood pressure, glycemic level, pain and quality of life in diabetic patients with end-stage renal disease as compared to the control group. Mean values showed that there was a statistically significant difference in different variables between both groups. Conclusion: It was concluded that there is a statistically significant difference between both groups in the improvement of limb pain and limb muscle strength by low-impact strengthening exercises. These exercises have positive effects on diabetic patients with end-stage renal disease in the treatment group as compared to the control group.

Challenges in Management of Diabetic Patient on Dialysis

Diabetes mellitus is the leading cause of end-stage kidney disease in many countries. The management of diabetic patients who receive dialysis can be challenging. Diabetic dialysis patients have higher rates of cardiovascular events and mortality due to metabolic factors and accelerated vascular calcification. Diabetic haemodialysis patients have high rates of haemodynamic instability which leads to organ ischaemia and end organ damage; autonomic dysfunction seems to play an important role in haemodynamic instability and abnormal organ perfusion during haemodialysis. Poor glycaemic control contributes to fluid overload and worse cardiovascular outcome. Xerostomia and thirst are the main drivers for fluid overload in haemodialysis patients and in peritoneal dialysis a chronic state of hyperhydration that is related to absorption of glucose from the PD fluids, protein loss and malnutrition contributes to fluid overload. Glycaemic control is of great importance and adjustments to diabetic agents are required. In haemodialysis, a reduction in insulin dose is recommended to avoid hypoglycaemia whereas in peritoneal dialysis an increase in insulin dose is often required. Foot ulcers and infection are more common in diabetic dialysis patients compared to non-diabetic dialysis patients or diabetic patients with normal renal function and regular surveillance for early identification is important. Ultimately, a multi-disciplinary approach which includes diabetologist, nephrologist, dietitians, microbiologist, vascular surgeon, interventional radiologist is required to address the complicated aspects of diabetic patient care on dialysis.

Prevalence of ABO Blood Grouping among Hemodialysis Patients in Dubai

Background: Beyond their vital role in blood transfusion, ABO antigens were speculated to be involved in developing various human illnesses, including infectious, neoplastic, cardiovascular, and many others. Many researchers attempted to highlight the relationship between kidney disease and ABO phenotypes. The majority of these reports showed a predominance of blood group O antigen among patients with chronic kidney disease, while few had opposed these findings. We aimed in this study to elaborate on blood group typing among our hemodialysis patients and whether it has a prognostic effect on the overall mortality. Methods: This is an observational, cross-sectional, retrospective study among chronic adult hemodialysis patients being dialyzed at Dubai Hospital over the past six months, from Jan 2021 till June 2021. The patient's demographic characteristics (age, sex, etiology of chronic kidney disease, medical comorbidities, and blood groups) were retrieved using an electronic hospital medical record system. Results: Our study population constituted 224 hemodialysis patients; their mean age was 55.4 years (16-94 years), 83.6% were UAE nationals, and 59.8% were males. Diabetic nephropathy was the etiology of end-stage kidney disease in 46%. ABO blood group distribution among our study population was as follows; group O was the commonest (45%), followed by group B positive (23%) and A Positive (20.9%). Among the UAE national patients group, O+ constitutes 46.9%, followed by B+ in 24%, and A+ in 21%. Nevertheless, group O+ was still the commonest among the nonnational hemodialysis patients in 37.7%, A+ in 28.8%, and B+ in 24.4%. Additionally, group O-positive was the predominant group among all diabetic dialysis patients (47%). Nine patients died during the study period of different causes; out of them, 4 patients (44.4%) had group O positive. Conclusion: Blood group O was the commonest blood group among our hemodialysis patients. Additionally, it was the commonest group in all diabetic dialysis patients. More studies from Arab countries are needed to comprehend the relationship between ABO blood phenotypes and kidney disease and whether certain blood groups have any role in a patient's progression to ESKD.

The Relationship between Sleep Quality and Hemodialysis and Nursing Intervention in Uremia Patients Based on Intelligent Data.

Uremia is a manifestation of end-stage renal failure and is a clinical syndrome shared by various advanced renal diseases. In recent years, the prevalence of uremia has been increasing. Maintenance hemodialysis therapy is used as the treatment of choice for uremia and is widely used. For uremia, the day-to-day treatment has a serious impact on the patient's symptoms, causing a lot of unnecessary burdens to life. While imposing a severe symptom burden on patients, excessive sleep deprivation repair time can cause various risk injuries and further increase the probability of patient mortality. The resulting sleep deprivation can lead to the functional damage of multiple organs and systems such as the cardiovascular system and the immune system. Therefore, improving sleep quality can increase the survival rate of patients to a certain extent. There is less domestic attention to its related research, and there are not many discussions on the pathogenesis. Based on this, this paper proposes to explore the effect of hemodialysis on the sleep quality of patients with uremia under the support of intelligent data. In this study, it was found that MHD patients had various sleep quality problems, and the incidence of sleep disturbance was 61.78%. The experimental results in this paper show that the incidence of sleep disturbance in diabetic nephropathy is 89.7%. This may be combined with a series of complications in patients with diabetes, which in turn affects the quality of sleep in patients. It may increase patient mortality and affect patient quality of life and survival. Therefore, we should pay close attention to the prevention of various complications in diabetic dialysis patients, which will help to improve sleep quality.

Do Not Recommend Chromium Supplements for Diabetic Dialysis Patients

Do Not Recommend Chromium Supplements for Diabetic Dialysis Patients

Effect of anti-diabetic drugs in dialysis patients with diabetes: a nationwide retrospective cohort study

BackgroundType 2 diabetes mellitus is common in patients undergoing dialysis. However, the association between anti-diabetic drug use and survival outcomes is rarely discussed. We aimed to investigate whether continued anti-diabetic medication use affects the survival of diabetic dialysis patients and whether different hypoglycemic drug use influences prognosis.MethodsUsing a nationwide database, we enrolled patients with incident end-stage renal disease under maintenance dialysis during 2011–2015 into the pre-existing diabetes dialysis (PDD), incident diabetes after dialysis (IDD), and non-diabetic dialysis (NDD) groups. The PDD group was further subclassified into patients who continued (PDD-M) and discontinued (PDD-NM) anti-diabetic drug use after dialysis.ResultsA total of 5249 dialysis patients were examined. The PDD-NM group displayed a significantly higher mortality rate than the IDD, PDD-M, and NDD groups (log-rank test P < 0.001). The PDD-M group had a significantly lower risk of death, regardless of insulin (P < 0.001) or oral hypoglycemic agent (OHA) (P < 0.001) use. Initial insulin administration or OHA had no statistically significant effect on overall mortality in the IDD group. But OHA use had better survival trends than insulin administration for the older (P = 0.02) and male subgroups (P = 0.05).ConclusionsFor dialysis patients with diabetes, continuous administration of anti-diabetic drugs after dialysis and choice of medication may affect outcomes.

A Sweet Dream with SGLT2 Inhibitors

Glucose is an osmotic agent in the peritoneal dialysis fluid (PDF) to absorb water, sodium and other toxins. Glucose absorption from PDF to blood impairs peritoneal dialysis (PD) efficiency and cause glycemic burden. This extra glycemic load leads to poor glycemic control in diabetic dialysis patients with PD program. Studies have shown sodium-glucose co-transporter (SGLT)-2 expression in peritoneal mesothelial cells. Blockade of peritoneal SGLT reduced blood glucose increment and increased peritoneal glucose retention in mice. In rat models, it was shown that high glucose PDF promotes the peritoneal fibrosis by upregulating the expression of glucose transporter (GLUT) and SGLT, and addition of phlorizin to PDF leads to downregulation of GLUT and SGLT expression and reduced peritoneal degeneration. According to these information, we want to share our experience of using empagliflozin in a poor glycemic controlled type 2 diabetic patient, who was on PD program for end-stage renal disease. We hypothesized that if we administer empagliflozin to our patient we can reduce glycemic burden caused by PDF and increase the ultrafiltration volume.

Dietary modifications achieved successful resolution of symptoms of gastroparesis diagnosed by demonstrating gastric food retention after overnight fasting in diabetic dialysis patients: two case reports with literature review

BackgroundGastroparesis is frequently overlooked and difficult to treat. The diagnosis of gastroparesis requires standard upper gastrointestinal endoscopy to exclude gastric outlet obstruction and objective evidence demonstrating delayed gastric emptying. However, none of the internationally recommended methods for measuring gastric emptying including scintigraphy are covered by the Japanese health insurance system. Limitations in the diagnosis might be related to the disease being overlooked in Japan. Meanwhile, presence of retained food in the stomach after overnight fasting without obstruction is classically known to be suggestive of gastroparesis. Some recent reports have considered gastric food retention after an overnight fasting equivalent to delayed gastric emptying.Case presentationTwo diabetic dialysis patients presented with nausea, vomiting, and oral feeding intolerance in the absence of mechanical obstruction. Abdominal computed tomography, upper gastrointestinal endoscopy, and ultrasonography demonstrated gastric food retention after overnight fasting. The findings led to the diagnosis of gastroparesis. Appropriate dietary modifications alone successfully relieved the symptoms despite persistent delayed gastric emptying.ConclusionsDemonstrating retained food residue after fasting for sufficient duration might be a diagnostic alternative. Dietary modifications alone provided significant clinical benefits. Possible approaches for the diagnosis and treatment of gastroparesis in Japan should be investigated.

Intestinal dialysis in a uremic patient with diabetic nephropathy: A challenging case and a unique experience

Background: The beneficial use of intestinal (dietary) dialysis in patients with chronic renal failure has been increasingly described during the previous two decades. The cornerstone of the dietary management during intestinal dialysis is protein restriction that is compensated by adequate caloric intake. On the other hand the dietary management of diabetic patients includes calorie restriction that is compensated by adequate intake of proteins. Therefore, the dietary prescription of intestinal dialysis in diabetic patients can be challenging and are not expected to be convenient for many patients. However, a beneficial effect of intestinal in a patient with insulin dependent diabetes mellitus and symptomatic uremia has been reported. The aim of this paper is report a beneficial effect of intestinal dialysis in a diabetic uremic patient who had insulin dependent diabetes mellitus. Patients and methods: A 28-year-old female patient with insulin dependent diabetes mellitus, and symptomatic uremia and refused treatment with dialysis. She had marked weakness and was unable to stand and walk unaided. However, she didn’t have a life threatening uremic complication such as gastrointestinal bleeding or encephalopathy on referral. The patient was treated with intestinal dialysis. Results: The patient experienced amelioration of symptoms of uremia with improved general wellbeing in association with lowering of urea levels and creatinine during the period of therapy. She was unable to stand and walk unaided before the start of therapy, but she was able to climb more than 10 steps upstairs unaided after three weeks of therapy.

Higher skin autofluorescence detection using AGE-Reader™ technology as a measure of increased tissue accumulation of advanced glycation end products in dialysis patients with diabetes: a meta-analysis.

This meta-analysis was conducted to compare skin autofluorescence (SAF) levels as a measure of advanced glycation end products (AGEs) accumulation between diabetic and non-diabetic dialysis patients. Relevant studies were identified primarily by searching PubMed/MEDLINE and other online databases and manual searching of cross-references. Random-effects model was used to obtain standardized mean differences (SMD) as a summary statistic. Heterogeneity was tested with meta-regression and sub-group analyses. Publication bias and robustness of this meta-analysis were tested using funnel plot and sensitivity analyses. A total of 11 reports comparing SAF between diabetic and non-diabetic dialysis patients were finally included in this meta-analysis. Dialysis patients with diabetes showed significantly higher circulatory SAF levels than their non-diabetic counterparts (SMD = 0.39; P < 0.0001). The difference was more evident in hemodialysis modality (SMD = 0.40; P < 0.0001). A one-study leave-out sensitivity analysis validated the robustness of this meta-analysis. The presence of diabetes in dialysis patients is associated with increased AGEs accumulation reflected through SAF measurements using a novel and non-invasive AGE-Reader™ technology. Our findings are in support of considering anti-AGE therapeutic strategies in addition to standard glycemic management in dialysis patients with diabetes.

P1506IMPROVEMENTS IN MICROVASCULAR AND MACROVASCULAR DIABETES-RELATED COMPLICATIONS IN DIALYSIS PATIENTS

Abstract Background and Aims Newer data suggests that there has been a substantial reduction in the incidence of diabetic complications over the past 30 years. However, little is known about whether this reduction also applies to patients with diabetes and end stage renal disease. The present study examined the current prevalence and the changes in microvascular and macrovascular diabetes-related complications in dialysis patients. Method The study was carried out as a cross-sectional study of all 119 diabetic patients in chronic dialysis at our department during June 2019. Data on diabetes-related complications was obtained from the patients’ electronic medical records and compared with a historic control group of all 38 diabetic dialysis patients examined in 2004. Results Currently, 12.3% had foot ulcer, while 40.3% had a history of foot ulcer. Lower extremity amputations were seen in 19.3%, with 7.6 % being amputated above-knee level. Development of Charcot foot was seen in 3.4%, and 64.1% had diabetic retinopathy (27.2% with proliferations), 27.2% had maculopathy, and 18.4% had a visual acuity lower than 0.3. A total of 31.1% had atrial fibrillation or flutter, 14.3% had angina pectoris and 20.2% had a history of myocardial infarction. A history of stroke or transient ischemic attack was observed in 21.8% and 6.7%, respectively. Compared with data from the 2004 cohort, we found a significant reduction in the prevalence of current foot ulcers (p=0.013), proliferative retinopathy (p=0.007) and visual acuity lower than 0.3 (p=0.028). Conclusion The findings of this study indicate that there has been a reduction in current foot ulcers and eye complications over the past 15 years among diabetic dialysis patients, whereas the prevalence of amputations, cardiovascular and cerebrovascular complications remains high.

Risk Factors Before Dialysis Predominate as Mortality Predictors in Diabetic Maintenance Dialysis patients

Diabetic patients undergoing maintenance dialysis (MD) have a particularly high mortality rate. Many of the risk factors for mortality have been identified in diabetics who die before reaching end stage renal disease (ESRD), i.e. before dialysis (BD). In addition, many risk factors for mortality have been identified in diabetics after dialysis onset (AD). However, whether in the BD period there are long-term risk factors for AD mortality in diabetics is unknown. We therefore investigated a new concept, i.e. that clinical and biochemical risk factors during the BD stage affect long-term AD mortality. We performed a population based retrospective cohort study, in diabetic CKD patients in a single center in south Israel who initiated MD between the years 2003 and 2015. Clinical and biochemical data 12 months BD and 6 months AD were collected and evaluated for association with mortality AD using Cox’s proportional-hazards model. BD parameters that were found to be significant were adjusted for significant parameters AD, thus generating a “combined” regression model in order to isolate the contribution of BD factors on long term mortality. Six hundred and fifty two diabetic MD patients were included in the final analysis. Four independent BD parameters were found in the multivariate model to significantly predict AD mortality: age, BMI (inversely), pulse pressure (U-shaped) and cardiovascular comorbidity. AD independent risk factors for mortality were age, BMI (inversely) and albumin (inversely). Of note, BD factors remained dominantly significant even after additionally adjusting for AD factors. No association was found between either BD HbA1C levels or BD proteinuria and AD mortality. In diabetics who reach ESRD, BD parameters can predict long term AD mortality. Thus, some of the factors affecting the poor survival of diabetic MD patients appear to begin already in the BD period.

Mortality predictor pattern in hemodialysis and peritoneal dialysis in diabetic patients.

An excessive mortality in dialysis programs is the result of cardiovascular injuries and immune deficiency caused by uremic toxins. The vulnerability of dialysis patients is still increasing due to the growing number of diabetics, elderly and patients with a history of cardiovascular disease. Peritoneal dialysis (PD) and hemodialysis (HD) offer similar effectiveness during the first 2 years of the treatment. However, the survival advantage of HD subsequently appears. The problem of the factors responsible for the mortality during long-term PD and HD treatment was analyzed in our recently published investigation. A lower death risk for PD patients during the first several months was lessened over time, and, therefore, no survival advantage of PD was noticeable by the completion of the 2-year period. A sign of the diminishing benefit of PD was a high rate of modality switch - 57%, contrasting with 6% switched in the HD group. Longer observations confirmed that the extension of the treatment period above 2 years with HD was associated with improved survival among subgroups with cardiovascular disease and diabetes. A very relevant problem is the timely transfer of PD patients to the HD program, when an adequate nutritional intake cannot be ascertained and a decline of serum albumin level is observed. The aim of this overview was to compare the factors affecting the survival of diabetic patients in HD and PD patients.

Impact of heart failure and dialysis in the prognosis of diabetic patients with ischemic foot ulcers

AimTo establish the role of heart failure (HF) and dialysis (D) in the prognosis of diabetic patients with critical limb ischemia and foot ulcers (FUs). MethodsConsecutive diabetic patients with ischemic FUs who referred to our Diabetic Foot Centre were prospectively included. All patients underwent a preset limb salvage protocol including peripheral revascularization. According to the presence of HF and D, they were divided in four groups: group 1 without HF and without D defined as ischemic foot (IF); group 2 with HF and without D defined as heart ischemic foot (H-IF); group 3 without HF and with D defined as renal ischemic foot (R-IF); group 4 with HF and with dialysis defined as heart-renal foot (HR-IF). Survival with limb salvage, survival with major amputation and death were reported after 1 year of follow-up. Results136 patient have been included: 66 with IF, 26 with H-IF, 24 with R-IF and 20 with HR-IF. The mean age was 68,9 ± 9,7 years, the diabetes duration 20,7 ± 11,6 years, the mean HbA1c 62,7 ± 22,3 mmol/mol. 103/136 (75,7%) survived with limb salvage, 10/136 (7,4%) survived with major amputation, 23/136 (16,9%) died. The outcomes for group IF patients, H-IF, R-IF and HR-IF were respectively: survival with limb salvage (92,4%, 61,5%, 79,2% and 35%), survival with major amputation (6,1%, 7,7%, 8,3% and 10%), death (1,5%, 30,8%, 12,5% and 55%) χ = 0.0001. Heart failure was an independent predictor of death. DiscussionThe presence of heart failure and dialysis in diabetic patients with ischemic foot ulcers was associated to high risk of amputation and mortality.