Abstract

CORONEL, F.; CIGARRAN, S.  and  HERRERO, J.A.. Morbidity and mortality in diabetic patients on peritoneal dialysis: Twenty-five years of experience at a single centre. Nefrología (Madr.) [online]. 2010, vol.30, n.6, pp.626-632. ISSN 1989-2284.

Aims: To describe PD outcomes during 25 years in a single centre, comparing hospitalization rate, technique withdrawal, and survival between diabetic (DM) and non diabetic (NonDM) patients. Differences between diabetic 1 (DM 1) and 2 (DM 2) were also analyzed. Patients and methods: 118 DM patients (52 y/o, 74 men, 44 female) and 117 NonDM (53 y/o, 64 men, 53 female), with at least 2 months on PD, 25 ± 20 (2-109) and 29.4 ± 27 (2-159) months respectively, were included. Diabetics were divided in 66 DM 1 and 52 DM 2. Survival and hospitalization study was also analyzed in two different time periods: before 1992 (1981-1992) and post-1992 (1993-2005). Results: 93% NonDM and 75% DM were self-sufficient to manage PD technique (p <0.001) as well as 65% of 44 blind patients. The 28% of NonDM and the 15% of DM received a renal allograft (p <0.001). There is no difference in transfer to hemodialysis. The 18.6% of DM and the 4.3% of NonDM patients presented >4 comorbid factors at starting PD (p <0.001). Hospitalization (admissions/year) was higher in DM than in NonDM (3.4 vs 1.8, p <0.01) and also the hospitalization length (46 vs 22 days/year, p <0.01), without differences between DM 1 and DM 2. Admissions by cardiovascular events, infections, technical problems and peritonitis were more frequent in DM 2 than in NonDM and DM 1 (p <0.05). Mortality was 48% in DM and 22% in NonDM (p <0.001). Survival adjusted to comorbidity was higher in NonDM (p <0.001). Cerebrovascular disease was the highest risks factor on mortality in DM. Mortality was higher in DM 2 than in DM 1 (p <0.001). Age (HR 1.052, p <0.001), DM 2 (HR 1.96, p <0.01) and cerebrovascular disease (HR 4.01, p <0.001) were the more important risk factors. In post-1992 period, hospitalization rate and survival improved in DM 1 and NonDM patients. Conclusions: DM patients require more often outside aid to perform PD and have more comorbidity, less survival, and higher admissions than NonDM, but there is no difference in transfer to HD. Age and cardiovascular comorbidity are the factors involved in mortality. Technological advances and cumulative center experience could achieve dialysis outcome improvements in diabetic patients.

Keywords : End-stage renal disease; Peritoneal dialysis; Diabetes mellitus; Comorbidity; Hospitalization; Survival.

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