A Comparison of Outcomes between Diabetic and Nondiabetic Capd Patients in India

Abstract

Background Continuous ambulatory peritoneal dialysis (CAPD) has been an established modality of renal replacement therapy in India for a decade, but there is a paucity of published data on the outcome of CAPD patients in India. We analyzed our data to determine the overall predictors of survival and compared patient survival between diabetic and nondiabetic end-stage renal disease patients on CAPD. Methods Of 373 patients, 197 were diabetic (165 males, 32 females) and 176 nondiabetic (104 males, 72 females). Patients were followed for 22 ± 14 patient-months. Patients were prospectively followed until the study end point or death. Results Overall median survival was 48 patient-months. Median survival of diabetics (34.5 patient-months) was significantly inferior to nondiabetic patients (59 patient-months) p = 0.001. Overall patient survival at 1, 2, 3, 4, and 5 years was 90%, 72%, 60%, 49%, and 39%, respectively. Patient survival of diabetics versus nondiabetics at 1, 2, 3, 4, and 5 years was 85% versus 96%, 62% vs 82%, 48% vs 72%, 39% vs 62%, and 34% vs 42%, respectively. The relative risk of mortality in nondiabetics (34/176) was less than that in diabetic patients (71/197): odds ratio (OR) 0.43, 95% confidence interval (CI) 0.26 – 0.68; p = 0.001. On Cox regression analysis, diabetes (OR 1.95, 95% CI 1.23 – 3.07; p = 0.004), comorbidities (OR 0.39, 95% CI 0.25 – 0.61; p = 0.001), peritonitis (OR 1.79, 95% CI 1.19 – 2.68; p = 0.005), malnutrition (OR 0.52, 95% CI 0.29 – 0.94; p = 0.03), and residual glomerular filtration rate at initiation of CAPD (OR 0.87, 95% CI 0.81 – 0.93; p = 0.001) were significant predictors of overall mortality. Age (OR 0.68, 95% CI 0.45 – 1.03; p = 0.07), gender (OR 0.66, 95% CI 0.42 – 1.03; p = 0.06), and albumin level at initiation of CAPD (OR 0.92, 95% CI 0.64 – 1.33; p = 0.68) were not predictors of mortality. Age (56 ± 10 vs 46 ± 15 years, p = 0.001), comorbidities (51/197 vs 16/176, p = 0.001), peritonitis rate (0.68 vs 0.50 episodes/patient-year, p = 0.056), and severe malnutrition (27/197 vs 10/176, p = 0.002) were higher in diabetic than in nondiabetic patients. Conclusion In India the majority of CAPD patients are diabetic. Patient survival was inferior in diabetic compared to nondiabetic patients on CAPD, but survival was statistically similar after adjustment for comorbidities. Diabetes, comorbidities, residual glomerular filtration rate, peritonitis, and severe malnutrition are predictors of mortality in CAPD patients.

Predicting One-Year Mortality in Peritoneal Dialysis Patients: An Analysis of the China Peritoneal Dialysis Registry

“…We found diabetes to be an important risk factor affecting the prognosis of PD patients. Our findings are consistent with previous studies 32 , 36 . It has been reported that PD patients with diabetes have a 30% increased risk of death, compared to non-diabetic patients 37 .…”

Effect of metabolic syndrome on clinical outcomes of non‐diabetic peritoneal dialysis patients in India

“…However, publications regarding MS in non-diabetic patients are few 23,29 despite the fact that PD is an established mode of renal replacement therapy and almost half of the ESRD patients who opt for PD are non-diabetic. 18 We have shown in the present study that the patient and technique survival of non-diabetic PD with MS are significantly inferior compared to that of patients without MS. Similar to our study, Li et al 29 and Park et al 23 have also shown that patients with MS have worse survival than those of patients without MS. Park et al did not find any individual components of MS as a predictor of mortality while they found MS as a whole an important predictor of mortality.…”

“…Contrary to this we have previously reported that age, nutritional status on SGA and peritonitis are the risk factors of mortality in PD patients. 18,44 These observational differences may also be because of the exclusion of diabetic PD patients from the present study. The prevalence of MS increases with age in the general population.…”

“…16,17 Peritoneal dialysis (PD) has been an established mode of renal replacement therapy for more than two decades in India. 18 Diabetic PD patients have inferior survival compared to non-diabetic PD patients because of the fact that they are at greater risk of metabolic abnormalities and cardiovascular mortality. 18,19 The prevalence of MS may also be especially high in non-diabetic end-stage renal disease (ESRD) patients on PD because of the high glucose load from the dialysate 20,21 and other associated metabolic problems including lipid abnormalities especially hypertriglyceridaemia, protein depletion, and obesity.…”

“…18 Diabetic PD patients have inferior survival compared to non-diabetic PD patients because of the fact that they are at greater risk of metabolic abnormalities and cardiovascular mortality. 18,19 The prevalence of MS may also be especially high in non-diabetic end-stage renal disease (ESRD) patients on PD because of the high glucose load from the dialysate 20,21 and other associated metabolic problems including lipid abnormalities especially hypertriglyceridaemia, protein depletion, and obesity. 22 There are few published studies in the literature showing the prevalence and risk of MS in nondiabetic PD patients.…”