title: 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.
  
  
  CONCLUSIONS
  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.
authors: Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. narayan@sgpgi.ac.in
authors: Narayan
authors: N
authors: Prasad
authors: Amit
authors: A
authors: Gupta
authors: Archana
authors: A
authors: Sinha
authors: Anurag
authors: A
authors: Singh
authors: Raj Kumar
authors: RK
authors: Sharma
authors: Alok
authors: A
authors: Kumar
authors: Anupama
authors: A
authors: Kaul
mesh_terms: D000368:Aged; D015897:Comorbidity; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007194:India / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory; D012044:Regression Analysis