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[Morbidity and mortality in diabetic patients on peritoneal dialysis. Twenty-five years of experience at a single centre].
Nefrologia. 2010; 30(6):626-32.N

Abstract

AIMS

To describe PD outcomes over 25 years in a single centre, comparing hospitalisation rate, technique withdrawal, and survival between diabetic (DM) and non-diabetic (NonDM) patients. Differences between type 1 (DM1) and type 2 (DM2) diabetics were also analysed.

PATIENTS AND METHODS

One hundred and eighteen DM patients (52 year old average, 74 men, 44 female) and 117 Non-DM (53 year old average, 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 DM1 and 52 DM2. The survival and hospitalisation study was also analysed in two different time periods: before 1992 (1981-1992) and after 1992 (1993-2005).

RESULTS

93% Non-DM and 75% DM were self-sufficient to manage the PD technique (P<.001) as well as 65% of 44 blind patients. 28% of Non-DM and 15% of DM received a renal allograft (P<.001). There was no difference in transfer to haemodialysis. 18.6% of DM and 4.3% of Non-DM patients presented ≥4 comorbid factors on starting PD (P<.001). Hospitalisation (admissions/year) was higher in DM than in Non-DM (3.4 vs 1.8, P<.01) and also hospitalisation length (46 vs 22 days/year, P=.01), without differences between DM1 and DM2. Admissions due to cardiovascular events, infections, technical problems and peritonitis were more frequent in DM2 than in Non-DM and DM1 patients (P<.05). Mortality was 48% in DM and 22% in Non-DM (P<.001). Survival adjusted for comorbidity was higher in Non-DM (P<.001). Cerebrovascular disease was the highest risk factor for mortality in DM. Mortality was higher in DM2 than in DM1 and Non-DM (P<.001). Age (HR 1.052, P=.001), DM2 (HR 1.96, P<.01) and cerebrovascular disease (HR 4.01, P<.001) were the most important risk factors. In the post-1992 period, the hospitalisation rate and survival improved in DM1 and Non-DM patients.

CONCLUSIONS

DM patients more often require outside assistance to perform PD and have more comorbidity, lower survival, and higher admissions than Non-DM, but there is no difference in HD discontinuation. Age and cardiovascular comorbidity are the factors involved in mortality. Technological advances and cumulative center experience may achieve dialysis outcome improvements in diabetic patients. 

Authors+Show Affiliations

Servicio de Nefrología, Hospital Clínico San Carlos, Madrid. fcoronel.hcsc@salud.madrid.orgNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

spa

PubMed ID

21113211

Citation

Coronel, F, et al. "[Morbidity and Mortality in Diabetic Patients On Peritoneal Dialysis. Twenty-five Years of Experience at a Single Centre]." Nefrologia : Publicacion Oficial De La Sociedad Espanola Nefrologia, vol. 30, no. 6, 2010, pp. 626-32.
Coronel F, Cigarrán S, Herrero JA. [Morbidity and mortality in diabetic patients on peritoneal dialysis. Twenty-five years of experience at a single centre]. Nefrologia. 2010;30(6):626-32.
Coronel, F., Cigarrán, S., & Herrero, J. A. (2010). [Morbidity and mortality in diabetic patients on peritoneal dialysis. Twenty-five years of experience at a single centre]. Nefrologia : Publicacion Oficial De La Sociedad Espanola Nefrologia, 30(6), 626-32. https://doi.org/10.3265/Nefrologia.pre2010.Jul.10553
Coronel F, Cigarrán S, Herrero JA. [Morbidity and Mortality in Diabetic Patients On Peritoneal Dialysis. Twenty-five Years of Experience at a Single Centre]. Nefrologia. 2010;30(6):626-32. PubMed PMID: 21113211.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Morbidity and mortality in diabetic patients on peritoneal dialysis. Twenty-five years of experience at a single centre]. AU - Coronel,F, AU - Cigarrán,S, AU - Herrero,J A, PY - 2010/07/22/accepted PY - 2010/11/30/entrez PY - 2010/11/30/pubmed PY - 2011/1/21/medline SP - 626 EP - 32 JF - Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia JO - Nefrologia VL - 30 IS - 6 N2 - AIMS: To describe PD outcomes over 25 years in a single centre, comparing hospitalisation rate, technique withdrawal, and survival between diabetic (DM) and non-diabetic (NonDM) patients. Differences between type 1 (DM1) and type 2 (DM2) diabetics were also analysed. PATIENTS AND METHODS: One hundred and eighteen DM patients (52 year old average, 74 men, 44 female) and 117 Non-DM (53 year old average, 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 DM1 and 52 DM2. The survival and hospitalisation study was also analysed in two different time periods: before 1992 (1981-1992) and after 1992 (1993-2005). RESULTS: 93% Non-DM and 75% DM were self-sufficient to manage the PD technique (P<.001) as well as 65% of 44 blind patients. 28% of Non-DM and 15% of DM received a renal allograft (P<.001). There was no difference in transfer to haemodialysis. 18.6% of DM and 4.3% of Non-DM patients presented ≥4 comorbid factors on starting PD (P<.001). Hospitalisation (admissions/year) was higher in DM than in Non-DM (3.4 vs 1.8, P<.01) and also hospitalisation length (46 vs 22 days/year, P=.01), without differences between DM1 and DM2. Admissions due to cardiovascular events, infections, technical problems and peritonitis were more frequent in DM2 than in Non-DM and DM1 patients (P<.05). Mortality was 48% in DM and 22% in Non-DM (P<.001). Survival adjusted for comorbidity was higher in Non-DM (P<.001). Cerebrovascular disease was the highest risk factor for mortality in DM. Mortality was higher in DM2 than in DM1 and Non-DM (P<.001). Age (HR 1.052, P=.001), DM2 (HR 1.96, P<.01) and cerebrovascular disease (HR 4.01, P<.001) were the most important risk factors. In the post-1992 period, the hospitalisation rate and survival improved in DM1 and Non-DM patients. CONCLUSIONS: DM patients more often require outside assistance to perform PD and have more comorbidity, lower survival, and higher admissions than Non-DM, but there is no difference in HD discontinuation. Age and cardiovascular comorbidity are the factors involved in mortality. Technological advances and cumulative center experience may achieve dialysis outcome improvements in diabetic patients.  SN - 0211-6995 UR - https://www.unboundmedicine.com/medline/citation/21113211/[Morbidity_and_mortality_in_diabetic_patients_on_peritoneal_dialysis__Twenty_five_years_of_experience_at_a_single_centre]_ L2 - http://www.revistanefrologia.com/es/linksolver/ft/ivp/0211-6995/30/626 DB - PRIME DP - Unbound Medicine ER -