[Morbidity and mortality in diabetic patients on peritoneal dialysis. Twenty-five years of experience at a single centre].
OBJECTIVE
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.


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. ﻿
Servicio de Nefrología, Hospital Clínico San Carlos, Madrid. fcoronel.hcsc@salud.madrid.org
F
F
Coronel
S
S
Cigarrán
J A
JA
Herrero
D000328:Adult; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D002423:Cause of Death; D015897:Comorbidity; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality; D003928:Diabetic Nephropathies / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000150:complications; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation / Q000639:trends; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts / Q000706:statistics & numerical data; D010530:Peritoneal Dialysis / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000706:statistics & numerical data / Q000639:trends; D010538:Peritonitis / Q000453:epidemiology / Q000517:prevention & control; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012648:Self Care; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000209:etiology / Q000401:mortality