Diabetes Care：糖尿病增加维持性透析患者死亡风险

为了评价终末期肾脏疾病(ESRD)患者开始进行长期透析疗法后与糖尿病(DM)和新发DM有关的预测因子和危险因素，来自台湾奇美医学中心内科内分泌和代谢的田凯仁博士及其团队进行了一项研究(Epidemiology and mortality of new-onset diabetes mellitus after dialysis)，研究发现，在维持性透析患者中，已有DM和新发DM均与长期死亡率增高相关。研究结果在线发表于2013年5月30日的美国《糖尿病治疗》(Diabetes Care)杂志上，该杂志的影响因子为8.087。

研究人员对台湾全国健康保险研究资料库中1999年到2005年间开始接受透析疗法的ESRD患者的记录进行评价。随访病人时间从最初的透析疗法开始时间直至患者死亡、行移植手术、停止透析或直到2008年12月31日。新发DM和死亡率预测因子采用Cox比例风险模型计算。

结果显示，研究总共评价了51,487名接受透析疗法的患者，包括25,321名已有糖尿病患者、3,346名新发DM患者和22,820名非DM患者。三组患者平均年龄分别为61.8±11.5，61.6±13.7和56.5±16.6岁。第1年和第9年时，新发DM累积发病率分别为4%和21%。透析模式不是新发DM的危险因素(新发DM患者腹膜透析与血液透析风险比[HR]为0.94 [95% CI 0.83-1.06])。已有糖尿病与死亡风险增高80%相关(HR 1.81[95% CI 1.75-1.87])，而新发DM与死亡风险增高10%相关(HR 1.10[95% CI 1.03-1.17])。

研究表明，在维持性透析患者中，已有DM和新发DM均与长期死亡率增高相关，而透析模式与新发DM没有相关性。

Epidemiology and Mortality of New-Onset Diabetes Mellitus After Dialysis: Taiwan national cohort study.
Abstract
OBJECTIVEWe 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 METHODSIn 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.RESULTSA total 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]).CONCLUSIONSWhereas 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.