Development of a predictive model for early death in diabetic patients entering hemodialysis: a population-based study

The aim of this study was to investigate whether early death following the start of dialysis treatment can be explained by predialysis comorbid conditions, and to develop a prognostic model to predict early death in these patients. All patients with diabetes mellitus (DM) over 19 years of age entering hemodialysis in Catalonia in the 1997-2002 period (n = 1,365) were assessed from prospectively obtained data in the Catalan Renal Registry. Logistic regression was used to identify the risk factors associated with mortality at 3, 6 and 12 months of hemodialysis. Mortality at 3 months was found to be associated with age (RR: 1.53/10 years), low grades of functional autonomy, defined as limited (RR: 2.28) or special care (RR: 4.60), heart disease (RR: 2.23), and use of a catheter as the first vascular access (RR: 2.45). Malignant conditions and malnutrition were found to be additional significant risk factors for mortality at 12 months (RR: 1.68 and 1.74, respectively). Based on the multivariate analysis results, an individual prognostic model was formulated. This study confirms previous data suggesting that predialysis comorbid conditions are significantly associated with mortality in DM patients on dialysis and provides a prognostic model to help clinicians focus on various factors that may require attention before initiating this treatment.