Comparing Risk of New Onset Diabetes Mellitus in Chronic Kidney Disease Patients Receiving Peritoneal Dialysis and Hemodialysis Using Propensity Score Matching

Leighton R James,Chih-Chia Liang,I.-Kuan Wang,Hsin-Hung Lin,Che-Yi Chou,Jiung-Hsiun Liu,Chiu-Ching Huang,Ya-Fei Yang,Huey-Liang Kuo,Chiz-Tzung Chang

doi:10.1371/journal.pone.0087891

Leighton R James, Chih-Chia Liang + Show 8 more

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https://doi.org/10.1371/journal.pone.0087891

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Abstract

Chronic kidney disease (CKD) patients are at risk for developing new-onset diabetes mellitus (NODM) even after hemodialysis (HD) and peritoneal dialysis (PD) treatment. It is not clear if the incidence for NODM is different in CKD patients receiving HD and PD. This study compared the risk of NODM in PD patients and HD patients.MethodsAll HD and PD patients in Taiwan Renal Registry Database from 1997 to 2005 were included and all patients were followed to December 31, 2008. The risk of NODM was analyzed in PD patients and propensity score matched HD patients using logistic regression for early type NODM (< = 6 months after dialysis) and Cox regression for late type NODM (>6 months after dialysis).ResultsA total of 2548 PD patients and 10192 HD patients who had no diabetes on the initiation of dialysis were analyzed. The incidence for NODM was 3.7 per 100 patient/year for HD and 2.4 for PD patients. HD patients are more at risk for developing early type NODM (p<0.001) with an adjusted odds ratio of 1.41 [95% confidence interval (CI) 1.12–1.78)]. HD patients are more at risk for late type NODM (p<0.001) with an adjusted hazard ratio of 2.01 (95% CI: 1.77–2.29). Patient’s age was negatively associated with risk of early type of NODM (p<0.001) but positively associated with risk of late type NODM (p<0.001).ConclusionsChronic kidney disease patients receiving hemodialysis are more at risk for developing new-onset diabetes mellitus compared to those receiving peritoneal dialysis.

Highlights

New onset diabetes mellitus (NODM) is a common complication in chronic kidney disease (CKD) patients receiving peritoneal dialysis (PD) or hemodialysis (HD) [1]
Patients and 2548 of 3516 PD patients that had no diabetes on the initiation of dialysis were identified (Figure 1)
PD patients were significantly younger than HD patients (51.9614.8 years old vs. 59.663.5 years old, p,0.001) and a propensity score with matching for age was indicated

Summary

Introduction

New onset diabetes mellitus (NODM) is a common complication in chronic kidney disease (CKD) patients receiving peritoneal dialysis (PD) or hemodialysis (HD) [1]. The development of NODM is linked to an increased overall mortality in CKD patients [2,3]. Very limited studies investigated the incidence, risk factors and outcomes of NODM in PD and HD patients. CKD 5 patients receiving PD are usually younger than those receiving HD [15,16,17] and HD patients may be more at risk for developing NODM. To compare the risk of NODM in CKD 5 patients receiving PD or HD, a propensity score matching for age and comorbidity was used. The risk for NODM was determined using competing-risks analysis in this study

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Conclusion