Long-term outcomes of peritoneal dialysis patients with diabetes as a comorbid condition

Abstract

Objective To investigate the long-term outcomes of peritoneal dialysis (PD) patients with diabetes as a comorbid condition. Methods All diabetic patients who commenced PD between January 1, 1995 and June 30, 2012 at Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine were included in the present study. Patients were divided into diabetic kidney disease group(DKD group) and non-diabetic kidney disease group (NDKD group) according to their diagnosis of primary renal disease at the initiation of PD. They were followed until death, cessation of PD, transferred to other centers or to the end of study (June 30, 2013). Outcomes were analyzed by Kaplan-Meier method. Cox proportional hazards models were utilized to determine the predictors of outcomes. Results A total of 163 diabetic patients were enrolled in the study. Compared with patients in DKD group, patients in NDKD group had a significantly lower fasting plasma glucose, a higher serum C-reactive protein level, a higher normalized protein nitrogen appearance, a lower dialysate glucose exposure, a lower peritoneal creatinine clearance and were treated with lower dialysate dose (all P < 0.05). Kaplan-Meier analysis showed that patients in NDKD group had a worse patient survive compared to those in DKD group (log rank Chi-square=4.830,P=0.028). Patients in NDKD group had a marginally shorter peritonitis-free period (log rank Chi-square=3.297,P=0.069), however, there was no significant difference in technique survival between these two groups. Multivariate Cox regression analysis showed that older age (HR 1.047, 95%CI 1.022~1.073,P <0.001) and cardiovascular disease comorbidity (HR 2.200, 95%CI 0.1.269~3.814,P=0.005) and diabetes as a comorbid condition (HR 1.806, 95%CI 1.003~3.158,P=0.038) were the independent predictors for increased mortality. While higher serum C-reactive protein level (HR 1.023, 95%CI 1.008~1.036,P=0.003) was the independent predictor for shorter peritonitis-free period. Conclusion PD patients with diabetes as a comorbid condition had a higher mortality compared to those with diabetic kidney disease, and closer monitoring and extra attention in the former subgroup of patients are therefore warranted. Key words: Peritoneal dialysis; Diabetes mellitus; Diabetic kidney disease; Mortality