Comorbidity Profiles among Obese–Diabetic End-Stage Renal Disease Patients: Data from REIN Registry of PACA Region of France

Asmatullah Kakar,¹ Yosra Mouelhi,¹ Anderson Loundou,¹ Adeline Crémades,¹ Stephanie Gentile<sup>1,2

1</sup>Aix Marseille University School of Medicine — La Timone Medical Campus, EA 3279: CEReSS — Health Service Research and Quality of Life Center, Marseille, France; ²Assistance Publique, Hôpitaux de Marseille (AP-HM), Marseille, France

Correspondence: Asmatullah Kakar
Aix Marseille University School of Medicine — La Timone Medical Campus, EA 3279: CEReSS — Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, Marseille, 13005, France
Tel +33-4 9132 4470
Fax +33(0)4 91 38 44 82
Email asmatullah.kakar@gmail.com

Introduction: The proportion of new dialysis patients with comorbidities increased by an average of 5.6% per year in the Provence-Alpes-Côte d’Azur (PACA) region, with major increases in obese, cancer, and diabetic patients. This study aimed to describe comorbidity profiles among obese–diabetic end-stage renal disease (ESRD) patients in the Renal Epidemiology and Information Network (REIN) registry of the PACA region of France on December 31, 2018.
Methods: Data for this retrospective cross-sectional study were retrieved from the REIN registry of the PACA region. Data were analyzed using two models. Firstly, the ESRD patients were divided into two groups and binary logistic regression model used for the analysis of the data. Secondly, ESRD patients were divided into four groups and multinomial logistic regression model used. Univariate analysis was performed for group comparison using x² and t-tests, while binary logistic and multinomial logistic regression models were used for multivariate analysis to derive ORs and 95% CIs.
Results: Among the 4,491 ESRD patients in this study, 623 were obese–diabetic and 3,868 nonobese–nondiabetic and obese only/ diabetic only. Obese–diabetic ESRD patients were younger (< 75 years, OR 0.46, p< 0.001), smoked less (OR 0.51, p< 0.001), were mainly dialyzed at centers (OR 1.29, p=0.014), and less likely to be on the renal transplant waiting list (OR 0.46, p< 0.001) compared to the other group. Obese–diabetic ESRD patients also had more comorbidities, including cardiovascular diseases (OR 1.38, p=0.028), coronary insufficiency (OR 1.49, p=0.001) and chronic obstructive pulmonary disease (OR 1.75, p< 0.001), but had fewer cases of cancer (OR 0.68, p=0.024) compare to the other group.
Conclusion: Obese–diabetic patients with ESRD have many specific characteristics. These patients were younger, but had more cardiovascular comorbidities and were less likely to be on the waiting list for transplantation. They should receive special attention and be the subject of prevention and therapeutic education.

Keywords: comorbidities, ESRD, CKD, REIN, obesity, diabetes