Among people on dialysis for kidney failure, those with diabetes are at greater risk for death even after accounting for other factors known to affect this risk, according to a new study published in the Journal of Renal Nutrition.
Diabetes is the leading cause of kidney failure, which happens when kidney function declines to the point where the organs can no longer effectively filter waste products from your blood and excrete them into the urine. This happens due to the cumulative effects of high blood glucose, which damages the tiny blood vessels in the kidneys that are part of the organs’ filtering units (nephrons). Some loss of kidney function can take place without causing any symptoms — but kidney function blood tests can detect this process in its earlier stages. Once nephrons stop working they don’t start working again, so it’s important to take steps as early as possible to prevent loss of kidney function — including controlling blood glucose levels in people with diabetes.
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For the latest study, researchers looked at 308 hemodialysis patients in Japan between January 1997 and December 2005, with an average follow-up period of about 76 months (6 years, 4 months), as noted in a Healio article on the study. The average age of these participants was 58, and the median duration of hemodialysis was 4.1 years. About 60% of participants were men, and 32.8% had diabetes.
The researchers used a variety of measurements to group participants based on their muscle strength, muscle mass, and fat mass. Based on these measurements, each participant was assigned to one of four groups — normal body-mass index (BMI, a measure of body weigh that takes height into account), obese, sarcopenia (loss of skeletal muscle), and sarcopenia plus obesity. Normal BMI accounted for 38.7% of participants, obese accounted for 18.8%, sarcopenia accounted for 26.9%, and sarcopenia plus obesity accounted for 15.6%. The rate of diabetes was highest in the sarcopenia-plus-obesity group, at 54.2% of these participants. In fact, having diabetes made someone nearly 3.5 times as likely to have the combination of sarcopenia and obesity.
Diabetes linked to increase death risk in those undergoing hemodialysis
During the follow-up period, 100 of the 308 participants died. The researchers found that the death rate was higher in the sarcopenia and sarcopenia-plus-obesity groups than in the other two groups, showing that diabetes may increase the risk of death through its effects on body composition in people with kidney failure. But the presence of diabetes was also independently linked to the risk of death in all four groups — showing that even if it doesn’t have measurable effects on body composition, diabetes increases the death risk in people undergoing hemodialysis.
These results suggest that diabetes, along with older age, is one of the strongest predictors of death in people undergoing hemodialysis, the researchers wrote. More studies are needed to look at how having diabetes affects the risk for death in more diverse populations of people on dialysis. The main take-away for people with diabetes, though, is that’s best to avoid needing dialysis in the first place — and that means paying attention to both blood glucose control and kidney function as early as possible.
Want to learn more about keeping your kidneys healthy with diabetes? Read “Protecting Your Kidneys,” “Kidney Disease: Your Seven-Step Plan for Prevention” and “Ten Things to Know About Kidney Disease.”
