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Highest mortality during the last year before and the first year after start of dialysis treatment in type 2 diabetic patients with nephropathy.

PURPOSE OF REVIEW
The mortality of type 2 diabetic patients with renal disease is high during both the pre-dialysis period as well as the period under dialysis therapy. With respect to rare data in the literature it may be assumed that the mortality rate is especially high during the last year before and the first year after start of dialysis therapy.


RECENT FINDINGS
After reviewing the reports in the literature dealing with survival of diabetic patients with nephropathy it may be concluded that mortality is especially high during the year before and after initiating dialysis. There are exact survival data of type 2 diabetic patients under dialysis therapy but only few data concerning the survival during the last year prior to dialysis treatment. The possible reasons for this higher mortality shortly before and after start of dialysis are discussed in this article.


SUMMARY
The mortality in type 2 diabetic patients is especially high during the last year before and the first year after the start of dialysis therapy. However, only the higher mortality during the first year after initiating dialysis is well documented in the literature. Those patients who die early within 90 days of dialysis are not registered in the registries, therefore, the overall mortality during the first dialysis year is at least 5% higher than the registered. During both periods several factors may play a causal role in the high mortality, a higher prevalence of heart failure, and a progression of macroangiopathy with higher incidence of cardiovascular events due to traditional and non-traditional risk factors, especially inflammation and oxidative stress.