Association between Diabetes and Mortality Is Not Modified by Living Arrangements in Hemodialysis Patients in Japan

Key Points Living arrangements did not significantly modify the overall association between diabetes and mortality among hemodialysis patients in Japan. In women aged 65–89 years, hemodialysis patients living with others had significantly higher mortality risks than those living with a spouse. Frequent clinic visits and lifestyle support by medical staff may facilitate diabetes management and mitigate social isolation. Background Living arrangements, such as living alone or with a spouse, may affect mortality risk in hemodialysis patients with diabetes. This study investigated whether living arrangements modify the association between diabetes and mortality in community-dwelling hemodialysis patients in Japan. Methods Using data from 27 outpatient dialysis units, this retrospective cohort study analyzed 2799 community-dwelling hemodialysis patients (women: 33.7%) aged 40–89 years between April 2016 and March 2021. Each patient was placed into one of three categories according to living arrangements: living alone, with a spouse, or with others (excluding spouses). Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality. Interaction analyses were performed to assess the potential effect measure modification of the association between diabetes and mortality by living arrangements. The analyses were also conducted according to sex and age groups (40–64 and 65–89 years). Results A total of 835 deaths were observed during a mean follow-up period of 3.9 years. Diabetes showed a significantly higher mortality risk (HR, 1.63; 95% CI, 1.42 to 1.89) in all patients. However, patients living alone did not have a significantly higher mortality risk than those living with a spouse (HR, 1.04; 95% CI, 0.87 to 1.24). There was no significant interaction between diabetes and living arrangements ( P = 0.73). Women aged 65–89 years who were living with others had a significantly higher mortality risk than those living with a spouse (HR, 1.41; 95% CI, 1.04 to 1.92). Conclusions Living arrangements did not modify the association between diabetes and mortality in community-dwelling hemodialysis patients. Frequent clinic visits and lifestyle support by medical staff related to hemodialysis treatment may have facilitated diabetes management and mitigated the negative influence of social isolation, thereby reducing mortality risk.