title: Diabetic patients could do as well as non-diabetic patients without inflammation on peritoneal dialysis.
abstract: BACKGROUND
  Diabetic patients on peritoneal dialysis (PD) have lower survival and are more likely complicated with inflammation than their non-diabetic counterparts. Here, we explored the interaction effects between diabetes and inflammation on the survival of PD patients.
  
  
  METHODS
  Overall, 2,264 incident patients were enrolled from a retrospective cohort study in China. Patients were grouped according to the baseline levels of high-sensitive C-reactive protein (hsCRP, ≤3 mg/L or >3 mg/L) or serum albumin (SA, ≥38 g/L or <38 g/L). Then, several multivariable adjusted stratified Cox regression models were constructed for these groups to explore the predicted role of diabetes on all-cause or cardiovascular death under inflammatory or non-inflammatory conditions.
  
  
  RESULTS
  Diabetics on PD were more likely to have inflammation than non-diabetics on PD, and they presented with elevated hsCRP (52.7% vs. 47.3%, P = 0.03) or decreased SA (77.9% vs. 62.7%, P < 0.001) levels. After stratification by size of center and controlling for confounding factors, diabetes was found to predict all-cause death in patients with hsCRP >3 mg/L or SA <38 g/L but not in patients with hsCRP ≤3 mg/L or SA ≥38 g/L. Similarly, the presence of diabetes was an indication of cardiovascular death in patients with hsCRP >3 mg/L or SA <38 g/L. However, if further adjusted by baseline cardiovascular disease, the predicted role of diabetes on death related to cardiovascular disease in patients with SA <38 g/L disappeared.
  
  
  CONCLUSIONS
  Diabetic patients could do as well as non-diabetic patients without inflammation on peritoneal dialysis. Active strategies should be implemented to improve inflammation status in diabetic patients on PD.
authors.affiliation: Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Xu
authors.forename: QingFeng
authors.initials: Q
authors.lastname: Han
authors.forename: TongYing
authors.initials: T
authors.lastname: Zhu
authors.forename: Yeping
authors.initials: Y
authors.lastname: Ren
authors.forename: JiangHua
authors.initials: J
authors.lastname: Chen
authors.forename: HuiPing
authors.initials: H
authors.lastname: Zhao
authors.forename: MengHua
authors.initials: M
authors.lastname: Chen
authors.forename: Jie
authors.initials: J
authors.lastname: Dong
authors.forename: Yue
authors.initials: Y
authors.lastname: Wang
authors.forename: ChuanMing
authors.initials: C
authors.lastname: Hao
authors.forename: Rui
authors.initials: R
authors.lastname: Zhang
authors.forename: Xiaohui
authors.initials: X
authors.lastname: Zhang
authors.forename: Mei
authors.initials: M
authors.lastname: Wang
authors.forename: Na
authors.initials: N
authors.lastname: Tian
authors.forename: HaiYan
authors.initials: H
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D048909:Diabetes Complications / Q000401:mortality; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D006801:Humans; D007249:Inflammation / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism
chemical_list: D012709:Serum Albumin; D002097:C-Reactive Protein