Abstract
BackgroundTo evaluate associations between diabetes mellitus (DM) coexisting with hyperlipidemia and mortality in peritoneal dialysis (PD) patients.MethodsThis was a retrospective cohort study with 2939 incident PD patients in China from January 2005 to December 2018. Associations between the DM coexisting with hyperlipidemia and mortality were evaluated using the Cox regression.ResultsOf 2939 patients, with a median age of 50.0 years, 519 (17.7%) died during the median of 35.1 months. DM coexisting with hyperlipidemia, DM, and hyperlipidemia were associated with 1.93 (95% CI 1.45 to 2.56), 1.86 (95% CI 1.49 to 2.32), and 0.90 (95% CI 0.66 to 1.24)-time higher risk of all-cause mortality, compared with without DM and hyperlipidemia, respectively (P for trend < 0.001). Subgroup analyses showed a similar pattern. Among DM patients, hyperlipidemia was as a high risk of mortality as non-hyperlipidemia (hazard ratio 1.02, 95%CI 0.73 to 1.43) during the overall follow-up period, but from 48-month follow-up onwards, hyperlipidemia patients had 3.60 (95%CI 1.62 to 8.01)-fold higher risk of all-cause mortality than those non-hyperlipidemia (P interaction = 1.000).ConclusionsPD patients with DM coexisting with hyperlipidemia were at the highest risk of all-cause mortality, followed by DM patients and hyperlipidemia patients, and hyperlipidemia may have an adverse effect on long-term survival in DM patients.
Highlights
Lipid abnormalities are prevalent in the dialysis population and are influenced by several factors, such as diabetes, renal replacement modalities, dietary regimens, and drug use [1, 2]
A clear association of diabetes mellitus (DM) coexisting with hyperlipidemia and mortality can help stratify the risk of death in peritoneal dialysis patients
In the present study, associations between DM coexisting with hyperlipidemia and mortality were examined in patients on continuous ambulatory peritoneal dialysis (CAPD)
Summary
Baseline characteristics Of 3073 potential participants, 42 patients < 18 years of age were excluded, and 92 with a < 3-month follow-up were excluded. Of the 2939 patients with a median age of 50.0 (IQR 39.0–61.0) years, 1697 (57.7%) were men, 549 (18.7%) had DM, 533 (18.1%) had hyperlipidemia, 1915 (65.2%) had hypertension, and 410 (14.0%) had pre-existing CVD. Elderly age, hypertension, pre-existing CVD, higher body mass index levels, systolic BP, hemoglobin, and lower levels of diastolic BP were independently associated with a high risk of DM coexisting with hyperlipidemia. The following variables at baseline were included in the multinomial logistic regression model: age, sex, body mass index, systolic BP, diastolic BP, current smoking, current alcohol consumption, 24-h urine volume, hypertension, pre-existing CVD, hemoglobin, serum albumin, serum uric acid, eGFR, cholesterol, triglyceride, high density lipoprotein, low density lipoprotein, and hs-CRP DM diabetes mellitus, CVD cardiovascular disease, BP blood pressure, eGFR estimated glomerular filtration rate, hs-CRP high-sensitivity C-reactive protein, OR odds ratio, CI confidence interval. Among non-DM patients, hyperlipidemia patients had a similar risk of all-cause mortality (HR 0.97, 95% CI 0.70 to 1.35) as non-hyperlipidemia patients
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