Early initiation of peritoneal dialysis in diabetic patients.
OBJECTIVE
Starting dialysis earlier in diabetic patients than in other patients with chronic kidney disease slows the progression of some diabetic complications, and could affect the survival outcome. The aim of this study is to assess the effect of starting dialysis early in diabetic patients on survival and hospitalization outcome.


METHODS
One-hundred diabetic patients on peritoneal dialysis (PD), 54 with type 1 and 46 with type 2 diabetes, were reviewed. Renal function was estimated by Modification of Diet in Renal Disease-7 (MDRD-7). The patients comprised two groups according to average MDRD-7 (7.7 ml/min/1.73 m(2)): group I > 7.7 (56 patients) and group II < or = 7.7 (44 patients). Survival was analysed by Kaplan-Meier plots and Cox hazard regression for the different variables.


RESULTS
MDRD-7 values (mean+/-SD) at the start of PD were 10.6+/-2.1 in group I and 5.4+/-1.2 in group II (p<0.001). Serum albumin (p<0.001) and haematocrit values (p=0.013) were higher in group I, while glycosylated haemoglobin was higher in group II. Kaplan-Meier plots showed higher survival, at 3 years, in group I than in group II (61% vs 39%, p=0.007). In patients with type 2 diabetes there was also greater survival in patients who began PD early compared with later PD initiation. In univariate analysis cerebrovascular pathology had a major influence on survival (odds ratio 2.94, 95% confidence interval 1.3-6.3, p=0.006). Multivariate analysis showed that age and initial serum albumin, and comorbidities such as cerebrovascular disease and cardiac failure, were the factors with the greatest impact on survival.


CONCLUSIONS
Early initiation of peritoneal dialysis in diabetic patients seems to improve patient survival. Initial serum albumin and age, and the presence of cerebrovascular pathology and cardiac failure are critical factors affecting survival outcome.
Coronel
Francisco
F
Nephrology Department, Hospital Clinico, San Carlos, Madrid, Spain. fcoronel.hcsc@salud.madrid.org
Cigarran
Secundino
S
Herrero
Jose Antonio
JA
D000328:Adult; D000368:Aged; D003404:Creatinine / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D003928:Diabetic Nephropathies / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies
D003404:Creatinine