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. 2017 Mar 15;12(3):e0173785.
doi: 10.1371/journal.pone.0173785. eCollection 2017.

Bidirectional association between ESRD dialysis and diabetes: National cohort study

Yeh-Wen Chu  1 , Wen-Shiann Wu  2   3 , Chen-Fang Hsu  4 , Jhi-Joung Wang  5 , Shih-Feng Weng  6 , Chih-Chiang Chien  1
Affiliations

Bidirectional association between ESRD dialysis and diabetes: National cohort study

Yeh-Wen Chu et al. PLoS One. .

Abstract

Background: 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).

Methods: Using 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.

Results: In 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).

Conclusions: ESRD 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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Cumulative incidence of ESRD dialysis by type 2 diabetes cohort and control cohort (general population without diabetes).
Fig 2
Fig 2. Cumulative incidence of new-onset diabetes by ESRD dialysis cohort and control cohort (general population without ESRD dialysis).
See this image and copyright information in PMC

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