Epidemiology and mortality of new-onset diabetes after dialysis: Taiwan national cohort study

Abstract

Objective: We examined the predictors and risks associated with pre-existing versus new-onset diabetes mellitus (DM) after initiation of chronic dialysis therapy in end-stage renal disease (ESRD) patients.

Research design and methods: In the Taiwan National Health Insurance Research Database, we examined records of ESRD patients who initiated dialysis between 1999 and 2005. Patients were followed until death, transplant, dialysis withdrawal, or 31 December 2008. Predictors of new-onset DM and mortality were calculated using Cox models.

Results: A total of 51,487 incident dialysis patients were examined in this study, including 25,321 patients with pre-existing DM, 3,346 with new-onset DM, and 22,820 without DM at any time. Patients' age (mean±SD) was 61.8±11.5, 61.6±13.7, and 56.5±16.6 years in pre-existing, new-onset DM, and without DM groups, respectively. The cumulative incidence rate of new-onset DM was 4% at 1 year and 21% at 9 years. Dialysis modality was not a risk factor for new-onset DM (peritoneal dialysis to hemodialysis hazard ratio [HR] of new-onset DM, 0.94 [95% CI 0.83-1.06]). Pre-existing DM was associated with 80% higher death risk (HR 1.81 [95% CI 1.75-1.87]), whereas the new-onset DM was associated with 10% increased death risk (HR 1.10 [95% CI 1.03-1.17]).

Conclusions: Whereas dialysis modality does not appear to associate with new-onset DM, both pre-existing and new-onset DM are related to higher long-term mortality in maintenance dialysis patients.

Figure 1

Crude overall survival curves after initiation of dialysis stratified by pre-existing DM (n = 25,321), new-onset DM (n = 3,346), and non-DM (n = 22,820) in ESRD dialysis patients. (A high-quality color representation of this figure is available in the online issue.)