Peritoneal Dialysis as an Option for Unplanned Dialysis Initiation in Patients with End-Stage Renal Disease and Diabetes Mellitus

Jin, Haijiao; Ni, Zhaohui; Che, Xiajing; Gu, Leyi; Zhu, Mingli; Yuan, Jiangzi; Huang, Jiaying; Gu, Aiping; Jin, Yan; Hao, Yan; Wang, Qin; Yu, Zanzhe; Zhou, Wenyan; Fang, Wei

doi:10.1159/000493176

Cited by 14 publications

(15 citation statements)

References 19 publications

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“…Currently, the only report published on patients with diabetes undergoing USPD included 50 participants and reported an early mortality rate of 4.1%[ 14 ], similar to that of the present study. Moreover, we have demonstrated for the first time that the mortality in patients with diabetes undergoing USPD is highest in the first 6 mo.…”

Section: Discussionsupporting

confidence: 86%

“…Studies on patients undergoing peritoneal dialysis have shown that those with diabetes mellitus (DM) have a poorer prognosis than do those without DM, in addition to a poorer survival rate owing to the high prevalence of cardiovascular diseases[ 12 , 13 ]. Currently, there is only a small, single-center study published on USPD in ESRD patients with diabetes[ 14 ]; it mainly compares the characteristics and complications between patients with diabetes treated with USPD and USHD. However, it does not identify the risk factors for mortality in patients with diabetes undergoing USPD.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for mortality within 6 mo in patients with diabetes undergoing urgent-start peritoneal dialysis: A multicenter retrospective cohort study

Cheng¹,

Yang²,

Sun³

et al. 2022

WJD

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BACKGROUND The risk of early mortality of patients who start dialysis urgently is high; however, in patients with diabetes undergoing urgent-start peritoneal dialysis (USPD), the risk of, and risk factors for, early mortality are unknown. AIM To identify risk factors for mortality during high-risk periods in patients with diabetes undergoing USPD. METHODS This retrospective cohort study enrolled 568 patients with diabetes, aged ≥ 18 years, who underwent USPD at one of five Chinese centers between 2013 and 2019. We divided the follow-up period into two survival phases: The first 6 mo of USPD therapy and the months thereafter. We compared demographic and baseline clinical data of living and deceased patients during each period. Kaplan-Meier survival curves were generated for all-cause mortality according to the New York Heart Association (NYHA) classification. A multivariate Cox proportional hazard regression model was used to identify risk factors for mortality within the first 6 mo and after 6 mo of USPD. RESULTS Forty-one patients died within the first 6 mo, accounting for the highest proportion of mortalities (26.62%) during the entire follow-up period. Cardiovascular disease was the leading cause of mortality within 6 mo (26.83%) and after 6 mo (31.86%). The risk of mortality not only within the first 6 mo but also after the first 6 mo was higher for patients with obvious baseline heart failure symptoms than for those with mild or no heart failure symptoms. Independent risk factors for mortality within the first 6 mo were advanced age [hazard ratio (HR: 1.908; 95%CI: 1.400-2.600; P < 0.001), lower baseline serum creatinine level (HR: 0.727; 95%CI: 0.614-0.860; P < 0.001), higher baseline serum phosphorus level (HR: 3.162; 95%CI: 1.848-5.409; P < 0.001), and baseline NYHA class III-IV (HR: 2.148; 95%CI: 1.063-4.340; P = 0.033). Independent risk factors for mortality after 6 mo were advanced age (HR: 1.246; 95%CI: 1.033-1.504; P = 0.022) and baseline NYHA class III-IV (HR: 2.015; 95%CI: 1.298-3.130; P = 0.002). CONCLUSION To reduce the risk of mortality within the first 6 mo of USPD in patients with diabetes, controlling the serum phosphorus level and improving cardiac function are recommended.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Risk factors for mortality within 6 mo in patients with diabetes undergoing urgent-start peritoneal dialysis: A multicenter retrospective cohort study

Cheng¹,

Yang²,

Sun³

et al. 2022

WJD

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“…Four studies met the inclusion criteria (18)(19)(20)(21), involving 108,413 patients. In the 4 studies, the sample size ranged from 30 to 98,891 cases, and the age of the subjects was mostly concentrated between 45 and 65 years old.…”

Section: Search Results and Basic Information Of The Included Studiesmentioning

confidence: 99%

Systematic review and meta-analysis: the effect and safety of peritoneal dialysis in patients with end-stage diabetic kidney disease

Wu¹,

Zhou²,

Zhang³

et al. 2022

Ann Palliat Med

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Background: At present, peritoneal dialysis (PD) is widely used in the clinical treatment of patients with end-stage renal disease (ESRD), and comparison of the efficacy of PD and hemodialysis (HD) in the treatment of diabetic kidney disease (DKD) has been reported in a few clinical studies.Methods: In this study, "dialysis", "peritoneal dialysis", "renal replacement therapy", "end-stage renal disease", "diabetic renal disease", and "efficacy and safety" were used as search terms in Chinese and English databases. According to RevMan 5.3 and Stata 13 software provided by the Cochrane Collaboration, a metaanalysis was performed.Results: Four randomized controlled trials were included in this study, and 3 trials described the randomization method, 3 described allocation concealment in detail, and 2 used the blinding method.Compared with the HD treatment in the control group, the PD treatment in the experimental group can significantly reduce the hemoglobin of patients with end-stage DKD [Mean difference (MD) =-0.13, 95% confidence interval (CI): -0.21 to -0.04; P=0.003<0.05] and Albumin level (MD = -0.10, 95% CI: -0.16 to -0.04; P=0.002<0.05). Compared with the control group, the PD treatment in the experimental group significantly increased the serum creatinine and blood urea nitrogen levels in patients with end-stage DKD, but there was no significant difference in the effects of PD and HD treatment on serum creatinine levels (MD =-0.30, 95% CI: -0.77 to 0.16; P=0.20>0.05), (MD =1.93, 95% CI: -2.65 to 6.51; P=-0.41>0.05). In addition, PD treatment in the experimental group significantly increased the probability of malignant tumors in patients with end-stage DKD [odds ratio (OR) =1.86, 95% CI: 1.64 to 2.10; P<0.00001], and the difference was significant.Discussions: This study used meta-analysis to confirm that PD can significantly improve the renal function of patients with end-stage DKD, but it can also increase the probability of protein loss and complications.

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“…They suggested that exchanges were performed with an initial infusion volume of 20-30 mg/kg (2 L average), dwell time lasted 30-50 min and the total exchanges ranged from 18 to 22 cycles. However, on basis of our previous experience, [18][19][20][21] a relatively low-dose PD prescription might be more suitable than HVPD for Asian population with relatively small body size, considering complications and outcomes.…”

Section: Discussionmentioning

confidence: 99%

Automated peritoneal dialysis as a cost-effective urgent-start dialysis option for ESRD patients: A prospective cohort study

Jin

et al. 2022

Int J Artif Organs

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Background Several studies have reported the feasibility of urgent-start peritoneal dialysis (PD) as an alternative to hemodialysis (HD) using a central venous catheter (CVC). However, the cost-effectiveness of automated peritoneal dialysis (APD) as an urgent-start dialysis modality has not been directly evaluated, especially in China. Methods We prospectively enrolled patients with end-stage renal disease (ESRD) who required urgent-start dialysis at a single center from March 2019 to November 2020. Patients were grouped according to their urgent-start dialysis modality (APD and HD). Urgent-start dialysis conducted until 14 days after PD catheter insertion. Then, PD was maintained. Each patient was followed until July 2021 or death or loss to follow-up. The primary outcome was the incidence of short-term dialysis-related complications. The secondary outcome was the cost and duration of the initial hospitalization. Technique survival, peritonitis-free or bacteriamia-free survival and patient survival were also compared. Results Sixty-eight patients were included in the study, of whom 36 (52.9%) patients were in APD group. Mean follow-up duration was 20.1 months. Compared with the HD group, the APD group had significantly fewer short-term dialysis-related complications. The cost of initial hospitalization was also significantly lower in APD patients. There was no significant difference between APD and HD patients with respect to duration of the initial hospitalization, technique survival rate, peritonitis-free or bacteriemia-free survival rate, and patient survival rate. Conclusion Among ESRD patients with an urgent need for dialysis, APD as urgent-start dialysis modality, compared with HD using a CVC, resulted in fewer short-term dialysis-related complications and lower cost.

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Peritoneal Dialysis as an Option for Unplanned Dialysis Initiation in Patients with End-Stage Renal Disease and Diabetes Mellitus

Cited by 14 publications

References 19 publications

Risk factors for mortality within 6 mo in patients with diabetes undergoing urgent-start peritoneal dialysis: A multicenter retrospective cohort study

Risk factors for mortality within 6 mo in patients with diabetes undergoing urgent-start peritoneal dialysis: A multicenter retrospective cohort study

Systematic review and meta-analysis: the effect and safety of peritoneal dialysis in patients with end-stage diabetic kidney disease

Automated peritoneal dialysis as a cost-effective urgent-start dialysis option for ESRD patients: A prospective cohort study

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