The impact of diabetes mellitus on peritoneal dialysis: the Turkey Multicenter Clinic Study

• Published in: Renal failure Vol. 36; no. 2; p. 149
• Main Authors: Ozener, Cetin, Arikan, Hakki, Karayaylali, Ibrahim, Utas, Cengiz, Bozfakioglu, Semra, Akpolat, Tekin, Ataman, Rezzan, Ersoy, Fevzi, Camsari, Taner, Yavuz, Mahmut, Akcicek, Fehmi, Yilmaz, M Emin
• Format: Journal Article
• Language: English
• Published: England 01-03-2014
• Subjects: Adult; Aged; Amputation; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Diabetic Angiopathies - complications; Diabetic Cardiomyopathies - complications; Diabetic Nephropathies - therapy; Female; Glycated Hemoglobin A - metabolism; Heart Failure - complications; Humans; Kidney Failure, Chronic - therapy; Male; Middle Aged; Parathyroid Hormone - blood; Peripheral Arterial Disease - complications; Peritoneal Dialysis - adverse effects; Peritoneal Dialysis - mortality; Peritonitis - epidemiology; Peritonitis - etiology; Retrospective Studies; Risk Factors; Serum Albumin - metabolism; Survival Rate; Turkey - epidemiology
• ISSN: 1525-6049
• DOI: 10.3109/0886022X.2013.843275

It is well established that diabetic peritoneal dialysis (PD) patients have a higher mortality rate than the other PD population. This study was designed to determine the overall predictors of survival and compared mortality and morbidity between diabetic and non-diabetic Turkish PD patients.
We conducted a multicenter retrospective study with 915 PD patients [217 had diabetes mellitus (DM)]. Serum albumin, PTH, HbA1c, co-morbid diseases, dialysis adequacy (Kt/V), and peritoneal transport characteristics as well as peritonitis episodes and ultrafiltration failure during the follow-up period were recorded.
DM patients were older and had more co-morbidities than non-DM patients. Peritonitis rates were higher in DM patients (one episode per 35.9 patient months) compared to non-DM patients (one episode per 41.5 patient months) (p < 0.001). On Kaplan-Meier analysis, patient survival was significantly lower in DM patients with the 2-, 3- and 5-year patient survival rates of 90.8%, 87.8% and 78.2% in non-diabetics and 80.9%, 70.4% and 61.2% in diabetics, respectively. On Cox regression analysis, DM (HR 1.5, p = 0.022), age (HR 1.03, p < 0.001), baseline serum albumin (HR 0.39, p < 0.001), heart failure (HR 0.038, p = 0.038), peripheral artery disease (HR 1.83, p = 0.025) and amputation (HR 4.1, p = 0.009) at baseline were significant predictors of overall mortality.
Patient survival is lower in diabetic compared to non-diabetic patients on PD. Peritonitis rates were also higher in diabetic PD patients. DM, older age, albumin level and cardiovascular co-morbidities are predictors of mortality.