Diabetes Among Incident Hemodialysis Patients with ESKD: A Five-Year, Retrospective Mexican Study

Background: Diabetic nephropathy is the leading cause of End-Stage Kidney Disease (ESKD). The need to initiate dialysis ranges from 16% to 51.2%, predominantly as hemodialysis (HD). Mortality occurs in up to 70% of diabetic patients within the first year. Cardiovascular events and infections are common outcomes. Risk factors include advanced age, poor glycemic control, smoking, left ventricular hypertrophy, hypoalbuminemia, and neuropathy. Methods: This retrospective cohort included incident HD patients with ESKD treated at a Mexican reference center between January 2019 and December 2023. Patients were divided into two groups based on presence or absence of diabetes. They were followed for 12 months or until death or kidney transplantation (KT). Data were analysed using SPSS v.20. Predictors of mortality were determined by univariate, multivariate and survival via Kaplan-Meier analysis. A p-value < 0.05 was considered statistically significant. Results: 238 patients, 49.57% had diabetes, predominantly male (63.6%). Diabetic patients were older (59.49 ± 13.54 vs 45.15 ± 18.07 years; p<0.001) and had higher systolic blood pressure (147.77 ± 28.67 vs 139.45 ± 26.52 mmHg; p=0.003). They had more comorbidities: hypertension (89.8 vs 56.7%; p<0.001), dyslipidemia (23.7 vs 7.5%; p<0.001), ischemic heart disease (44.1 vs 10%; p<0.001) and cardiac failure (49.2 vs 25.8%; p<0.001). Non diabetic patients had a previous KT in 14.2 vs 4.2% (p=0.008). Diabetic patients had presented more frequently with edema, dyspnea, pleural effusion and, anasarca, along with lower serum creatinine, albumin and calcium-phosphorus product levels, as well as reduced LEFV and TAPSE, all with statistical significance (Table 1). Mortality was not significantly different between diabetic (13.6%) and non diabetic (10%) patients (Figure 1). KT occurred in 17.5% of non-diabetic vs. 3.4% of diabetic patients (p<0.001). Conclusion: Mortality among incident HD patients with ESKD in our center was relatively low. Diabetes was not an independent predictor of mortality. However, diabetic patients presented with a higher burden of comorbidities and fluid overload at the initiation of HD.