All-cause and cause-specific mortality associated with diabetes in prevalent hemodialysis patientsReport as inadecuate

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BMC Nephrology

, 13:130

First Online: 01 October 2012Received: 09 May 2012Accepted: 17 September 2012


BackgroundDiabetes is the most common risk factor for end-stage renal disease ESRD and has been associated with increased risk of death. In order to better understand the influence of diabetes on outcomes in hemodialysis, we examine the risk of death of diabetic participants in the HEMODIALYSIS HEMO study.

MethodsIn the HEMO study, 823 44.6% participants were classified as diabetic. Using the Schoenfeld residual test, we found that diabetes violated the proportional hazards assumption. Based on this result, we fit two non-proportional hazard models: Cox’s time varying covariate model Cox-TVC that allows the hazard for diabetes to change linearly with time and Gray’s time-varying coefficient model.

ResultsUsing the Cox-TVC, the hazard ratio HR for diabetes increased with each year of follow up p = 0.02 for all cause mortality. Using Gray’s model, the HR for diabetes ranged from 1.41 to 2.21 p <0.01. The HR for diabetes using Gray’s model exhibited a different pattern, being relatively stable at 1.5 for the first 3 years in the study and increasing afterwards.

ConclusionRisk of death associated with diabetes in ESRD increases over time and suggests that an increasing risk of death among diabetes may be underappreciated when using conventional survival models.

KeywordsCox regression Diabetes ESRD Hemodialysis Proportional hazard Survival model Time varying coefficient model Time dependent covariate. Electronic supplementary materialThe online version of this article doi:10.1186-1471-2369-13-130 contains supplementary material, which is available to authorized users.

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Author: Abdus Sattar - Christos Argyropoulos - Lisa Weissfeld - Nizar Younas - Linda Fried - John A Kellum - Mark Unruh


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