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Our objective was to analyze the survival of diabetic patients on renal replacement therapy and to compare their survival on extracorporeal and on peritoneal dialysis. All data regarding diabetic patients admitted to dialysis between 1 January 1983 and 31 December 1993 were collected by means of individual patient questionnaires sent to all of the 44 regional Renal Units (100% answers) of Lombardy, Italy. Cox proportional hazards model, stepwise procedure, was applied in order to select the covariates significantly associated with survival. Age (at baseline), sex, type of diabetes, initial modality of treatment (hemodialysis or peritoneal dialysis), and initial clinical risk factors (malignancies, serious heart disease, vascular disease, cirrhosis of the liver, cachexia) were considered. Descriptive analysis of survival was performed using the Kaplan-Meier technique. The survival of all diabetic patients (895) was 86.5% at one year, 52% at three years, and 34% at five years. The main causes of the 488 deaths of diabetic patients were cardiovascular diseases (56%), cachexia (18%), and infections (11%). The relative death risk of patients on peritoneal dialysis versus those on hemodialysis, after taking into account the main comorbid conditions, did not significantly differ from 1, as estimated by the Cox proportional hazards regression model. Five-year survival of diabetic patients was 34%, and no differences were found between peritoneal dialysis and hemodialysis as far as mortality is concerned.

Methods: This 1993 Lombardy Registry Report refers to all of the data regarding treated diabetics collected between 1 January 1983 and 31 December 1992 by means of individual patient questionnaires sent to all of Lombardy's 44 Renal Units (100% replies)., Results: The acceptance rate of diabetics for dialysis increased from 5.6 in 1983 to 10.4 patients per million population in 1992 for a total of 731 patients (379 type I, 352 type II). The yearly percentage of new diabetics increased from 9 to 11%, and the proportion of patients with two or more risk factors increased from 14.7% in 1983-1987 to 22.0% in 1988-1992. The use of peritoneal dialysis declined over the 10-year period from 50% in 1983-1984 to 30% in the last 2 years. The difference in age of the patients on peritoneal and haemodialysis tended to decrease. The survival of all diabetic patients was 82% at 1 year, 48% at 3 years, and 28% at 5 years. The relative death risk of the patients on peritoneal dialysis compared to those on haemodialysis, after taking into account age and the main comorbid conditions (type of diabetes, severe vascular disease, cirrhosis and the generic other risk factors), did not differ significantly from one, as estimated by the Cox proportional hazard regression model (344 events). The main causes of death of these patients were cardiovascular diseases (about 50.0%), cachexia (from 17.2% in 1983/1984 to 22% in 1991/1992), and infection (about 11%). The mean hospitalization rate was higher in diabetics than in patients with standard nephropathies (i.e. in 45-64-year-old patients: 32.8 versus 13.9 days/patient-year)., Conclusion: Multivariate analysis showed that age, type of diabetes, severe vascular disease, cirrhosis, and the generic other risk factors were significantly related to survival; but diabetic patients without any baseline risk factors also had a poor prognosis and morbidity was very high in absolute terms. Medical care therefore needs to be improved in order to reverse prognostic risk factors and prevent cardiovascular and noncardiovascular events.

This 1993 report of the Lombardy Regional Dialysis and Transplant Registry refers to all the data collected between January 1, 1983, and December, 31, 1992, by means of individual patient questionnaires sent to all of Lombardy's 44 renal units (100% replies). The number of patients recorded by the Registry as being alive progressively increased; by the end of 1992, the number was 6,014 (655 patients per million population): 4,770 patients were on dialysis treatment (515 patients per million population, 79.3%) and 1,244 patients (140 patients per million population, 20.7%) had received a kidney graft. The acceptance rate for dialysis increased from 64 per million population in 1983 to 102 per million population in 1992; the increase in the transplant rate was much lower (from 18.7 to 21.3 per million population). The percentage of primary nephropathies in the new patients accepted for dialysis treatment were 22.0% glomerulonephritis, 13.8% interstitial nephritis, 15.2% vascular diseases, 10.1% cystic kidney, and 10.6% diabetes. The use of acetate hemodialysis declined over the 10-year period from 72.4% to 17.5%; that of bicarbonate hemodialysis increased from 8.8% to 50.1% and that of hemodiafiltration increased from 0.2% to 11.1%. The prevalence of hospital hemodialysis was stable, ranging from 55.4% to 52.2%; home hemodialysis decreased from 15.7% to 5.3%, continuous ambulatory peritoneal dialysis increased from 13.3% to 19.6%, and limited care increased from 13.7% to 22.4%. The crude death rate increased from 7.5% in 1983 to 10.5% in 1992. The survival rate (Kaplan-Meier) of all patients on dialysis was 78.8% at 2 years, 62.2% at 4 years, and 40% at 8 years; for transplanted patients, the survival and graft survival rate at 2 years was, respectively, 95% and 86%. The relative death risk of the patients on peritoneal dialysis with respect to those on hemodialysis was 1.419, as estimated by the Cox proportional hazard regression model. The main causes of deaths of patients on dialysis treatment during the year 1992 were cardiovascular diseases (47.0%) and cachexia (19.5%); in transplanted patients, they were cardiovascular diseases (36.6%) and infections (34%). Registries are not only important for planning health care but are also very useful instruments for clinical research.

Plasma acetate (PA) kinetics was analysed in two groups of patients on regular dialysis treatment (RDT). The first group presented frequent symptomatic hypotension (SHY), the second did not experience SHY during RDT. The parameters examined showed no difference between the two groups. Seven patients of the first group were then switched to bicarbonate dialysis. SHY rate and blood pressure changes did not significantly differ between the two methods of treatment.