Perceived health-related quality of life and comorbidity in diabetic patients starting dialysis (CALVIDIA study)

• Published in: Journal of nephrology Vol. 17; no. 4; p. 544
• Main Authors: Martínez-Castelao, Alberto, Gòrriz, José Luis, Garcia-López, Fernando, López-Revuelta, Katia, De Alvaro, Fernando, Cruzado, Josep M
• Format: Journal Article
• Language: English
• Published: Italy 01-07-2004
• Subjects: Adult; Age Distribution; Aged; Aged, 80 and over; Cohort Studies; Comorbidity; Confidence Intervals; Diabetes Mellitus, Type 1 - diagnosis; Diabetes Mellitus, Type 1 - epidemiology; Diabetic Nephropathies - diagnosis; Diabetic Nephropathies - epidemiology; Diabetic Nephropathies - therapy; Female; Humans; Incidence; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - therapy; Kidney Function Tests; Longitudinal Studies; Male; Middle Aged; Odds Ratio; Prognosis; Prospective Studies; Quality of Life; Renal Dialysis - methods; Risk Assessment; Severity of Illness Index; Sex Distribution; Sickness Impact Profile; Treatment Outcome
• ISSN: 1121-8428
• DOI: 10.111/J.1121-8428

Diabetes mellitus (DM) is a widespread prevalent illness, currently the main cause of end-stage renal disease (ESRD).
In a longitudinal, prospective study we compared two cohorts of patients starting dialysis therapy, diabetic and non-diabetic ESRD patients. Perceived health was measured by the Medical Outcomes Study Short-Form 36 (SF-36) questionnaire, functional status by the Karnofsky scale and comorbidity by the Charlson age-comorbidity index. A broad spectrum of variables in relation to diabetes, ESRD, comorbidity and renal replacement therapy (RRT) were studied, as well as the distribution of comorbidity frequencies at dialysis start.
Thirty-four Spanish centers included 232 diabetic patients, 43 type 1 and 189 type 2, mean diabetes duration 18 +/- 9 yrs, and five centers included 121 non-diabetic patients. Out of the 232 diabetic patients, 187 patients (81%) started hemodialysis (HD) and 45 patients (19%) started peritoneal dialysis (PD) (vs. 82% and 18%, respectively in non-diabetic patients). Transient vascular access (VA) for starting RRT was required in 54% of the diabetic patients vs. 53% in the nondiabetic patients. When both study groups were compared, diabetic patients required antihypertensive drugs more frequently than non-diabetic patients and showed higher systolic blood pressure (BP), as well as higher cardiovascular (CV) complication incidences, poorer SF-36 physical component summary scores and mental component summary scores and worse Karnofsky scale scores, with the Charlson age-comorbidity score being higher.
Diabetic patients starting dialysis in Spain are more often type 2 diabetics, have worse perceived health-related quality of life (HRQoL) in relation to non-diabetic patients, worse functional status and higher incidences of prognostic mortality markers.