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

Özener, Çeti̇n; Arıkan, Hakkı; Karayaylalı, İbrahim; Utaş, Cengiz; Bozfakioğlu, Semra; Tekin, Mustafa; Ataman, Rezzan; Ersoy, Fevzi; Camsari, Taner; Yavuz, Mahmut; Akçiçek, Fehmi; Yilmaz, Murvet

doi:10.3109/0886022x.2013.843275

Cited by 29 publications

(19 citation statements)

References 29 publications

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“…Their patients were much younger (50.4 years versus 59.9 years) and had lower diabetes rate (27.9% versus 42%) than our patients. Both age and diabetes were independent risk factors for the mortality of PD patients in our study and previous studies [19][20][21]. However, when we adjusted the age and diabetes in subgroup analysis, these two variables didn't impact the prognosis of early-start PD.…”

Section: Discussioncontrasting

confidence: 73%

Early-start and conventional-start peritoneal dialysis: a Chinese cohort study on outcome

Wang

et al. 2020

Renal Failure

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Background: Early-start peritoneal dialysis (PD) is an effective option for patients need unplanned dialysis. However, there are few studies on the long-term prognosis of early-start PD patients. Methods: In this retrospective study, 635 eligible patients from 1 March 1996 to 30 September 2016 were included, and divided into three groups according to the duration of break-in period: 3 days or less, 4-13 days and more than 14 days. Patients started PD within 2 weeks and after 2 weeks were defined as early-start and conventional-start, respectively. The primary outcome was all-cause mortality, and the secondary outcome measures were peritonitis free survival and technical survival. Mechanical and infectious complications in the first 180 days were also analyzed. Results: Early-start PD patients were more likely to have higher serum total carbon dioxide and creatinine levels and lower serum albumin, Kt/v, creatinine clearance (Ccr) and residual glomerular filtration rate (rGFR) levels at the start of PD. The median follow-up period was 30 months (interquartile range, 13-53 months). A worse survival was observed in the early-start group than that in the conventional-start group (p < 0.001), even adjustment for the covariates (HR 1.549, 95%CI 1.104-2.173, p ¼ 0.011). In the subgroup analysis, in patients commencing PD after 2006 early-start and conventional-start PD patients had comparable survival. No differences were observed in the rate of infectious and mechanical complications, peritonitis-free survival and technique survival between early-start and conventional-start PD patients. Conclusions: Early-start PD could be a safe and effective strategy for patients needing unplanned dialysis initiation with the progress of technology on PD.

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Section: Discussioncontrasting

confidence: 73%

Early-start and conventional-start peritoneal dialysis: a Chinese cohort study on outcome

Wang

et al. 2020

Renal Failure

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“…Factors like inflammation, solution bioincompatibility, acidosis, or hyperglycemia were also affected by PD outcomes [55,56]. The diabetic population was reported to have higher risk of peritonitis, ultrafiltration failure, insulin resistance, worse glycemic control, and lower survival rate compared to nondiabetic patient on PD [57,58]. Above all, these mechanisms might explain our results, which suggested the higher mortality risk in diabetic PD patients compared with those in HD.…”

Section: Discussionmentioning

confidence: 64%

Comparison of peritoneal dialysis with hemodialysis on survival of diabetic patients with end-stage kidney disease: a meta-analysis of cohort studies

Xue

Zhou

et al. 2019

Renal Failure

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Aim: Renal replacement therapy was primary treatment for end stage kidney (ESRD) patients. Numbers of studies comparing peritoneal dialysis (PD) and hemodialysis (HD) yielded inconsistent results. The aim of this study was to assess the mortality risk between diabetic PD patients and those in HD. Methods: We included cohort studies comparing the risk of death among diabetic ESRD patients who receiving peritoneal dialysis or hemodialysis by searching Medline and Embase. Overall estimates were calculated using the random-effects model. Results: Seventeen studies were included in the meta-analyses. Mortality comparison between PD and HD in the diabetic ESRD patients showed PD significantly increased mortality rate (hazard ratio (HR) 1.20; 95% confidence interval (CI) 1.10-1.30; I 2 ¼ 89.1%). The overall HR using an intention-to-treat analysis was 1.23 with 95% CI (1.13 to 1.34). Meta-regression demonstrated PD patients from Asian country were associated with increase in mortality risk (coefficient ¼ 0.270, SE ¼ 0.112, p ¼ .033). Limitation: The high heterogeneity in our meta-analyses undermined the robustness of the findings. Conclusion: ESRD patients with diabetes may benefit more from HD than PD.

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“…Moreover, Schroijen found similar mortality risk in HD patients from NECOSAD having diabetic nephropathy as primary disease as well as in those having DM as co-morbid condition. The mortality risk seems to be also increased in the peritoneal dialysis DM patients as compared to no DM ones [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Vitamin D Deficiency—Prognostic Marker or Mortality Risk Factor in End Stage Renal Disease Patients with Diabetes Mellitus Treated with Hemodialysis—A Prospective Multicenter Study

Schiller

Gădălean

Schiller³

et al. 2015

PLoS ONE

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BackgroundEnd stage renal disease (ESRD) patients on renal replacement therapy (RRT) with diabetes mellitus (DM) have a higher mortality rate and an increase prevalence of vitamin D deficiency compared to those without DM. It is still debated if vitamin D deficiency is a risk factor or a prognostic marker for mortality in these patients. This study investigated the prevalence of vitamin D deficiency and its impact on all-cause mortality in HD patients with DM.MethodsOur prospective non-interventional cohort study included 600 patients on hemodialysis therapy (HD) (median aged 56, interquartile range (19) years, 332 (55.3%) males) recruited from 7 HD centers, from all main geographical regions of Romania. The prevalence of DM was 15.3%. They were then followed regarding: dialysis duration, dialysis efficiency, renal anemia, CKD-MBD, inflammatory status and comorbidities: coronary artery disease (CAD), peripheral vascular disease (PVD) and stroke. The deficiency of 25-OH vitamin D was defined as a value lower than12 ng/mL.ResultsPatients were followed for 3 years. The overall 3 year mortality was 25.5% (153 individuals), being higher in patients with DM as compared to those without DM (33.7% vs. 24.0%; P = 0.049). The time-related prognosis was also influenced by the presence of DM, at the survival analysis resulting in a HR of 1.52 [1.03 to 2.26] 95% CI, P = 0.037, for death in dialyzed patients with DM. In DM patients, 25-OH vitamin D deficiency was significantly higher (37.0% compared to 24.0%, P = 0.009). Furthermore, in patients with DM we observed a shorter dialysis duration (2 vs. 3 years, P<0.001) and a lower intact parathyroid hormone (iPTH) (258.0 pg/ml vs. 441.9 pg/ml, P = 0.002). Regarding the presence of comorbidities at the inclusion in the study, the presence of diabetes in dialyzed patients was associated with increased prevalence of CAD (87.0% vs. 58.1%, P<0.001), PVD (67.4% vs. 17.3%, P<0.001) and history of stroke (29.3% vs. 14.0%, P<0.001). In patients with DM the presence of 25-OH vitamin D deficiency increased the probability of death (50.0% vs. 24.1%; P = 0.011). In multiple Cox proportional hazards analysis, vitamin D deficiency remained an independent predictor for mortality in dialysis patients with DM (HR = 1.71, 95% CI 1.21 to 2.43, P = 0.003). In the same time, multiple Cox proportional hazards analysis showed that age (HR = 1.02 per one year increase, P = 0.004), CAD (HR = 1.55, P = 0.046) and PVD (HR = 1.50, P = 0.029) were independent predictors for mortality in dialysis patients with DM.ConclusionsESRD patients with DM treated with HD have a higher overall mortality than non-DM patients. Vitamin D deficiency is significantly more prevalent in HD patients with DM. Low 25-OH vitamin D levels were associated with increased all-cause mortality in these patients. According to our data, in HD patients with DM, screening for vitamin D deficiency (and its correction) should be mandatory for an optimal risk reduction strategy.

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

Cited by 29 publications

References 29 publications

Early-start and conventional-start peritoneal dialysis: a Chinese cohort study on outcome

Early-start and conventional-start peritoneal dialysis: a Chinese cohort study on outcome

Comparison of peritoneal dialysis with hemodialysis on survival of diabetic patients with end-stage kidney disease: a meta-analysis of cohort studies

Vitamin D Deficiency—Prognostic Marker or Mortality Risk Factor in End Stage Renal Disease Patients with Diabetes Mellitus Treated with Hemodialysis—A Prospective Multicenter Study

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