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Early initiation of peritoneal dialysis in diabetic patients
Francisco Coronel1, Secundino Cigarran, Jose Antonio Herrero
1Nephrology Department, Hospital Clinico, San Carlos, Madrid, Spain. fcoronel.hcsc@salud.madrid.org
Insights
Starting peritoneal dialysis (PD) earlier for diabetic patients with chronic kidney disease improves survival rates. Key factors influencing outcomes include age, serum albumin, and comorbidities like cerebrovascular disease and cardiac failure.
Area of Science:
- Nephrology
- Diabetology
- Clinical Medicine
Background:
- Diabetic patients with chronic kidney disease (CKD) face unique challenges, including accelerated disease progression and potential complications.
- Early initiation of dialysis in CKD patients is a debated topic, with potential benefits for specific populations like diabetics.
Purpose of the Study:
- To evaluate the impact of early versus late initiation of peritoneal dialysis (PD) on survival and hospitalization outcomes in diabetic patients with CKD.
- To identify factors influencing survival in this patient cohort.
Main Methods:
- A retrospective review of 100 diabetic patients undergoing PD (54 type 1, 46 type 2).
- Patients were categorized into two groups based on Modification of Diet in Renal Disease-7 (MDRD-7) values: Group I (>7.7 ml/min/1.73 m(2)) and Group II (<=7.7 ml/min/1.73 m(2)).
- Survival analysis was performed using Kaplan-Meier plots and Cox regression.
Main Results:
- Group I (early PD initiation) demonstrated significantly higher survival rates at 3 years (61% vs. 39%, p=0.007) compared to Group II.
- Patients in Group I had higher serum albumin and hematocrit levels, while Group II had higher glycosylated hemoglobin.
- Multivariate analysis identified age, initial serum albumin, cerebrovascular disease, and cardiac failure as critical predictors of survival.
Conclusions:
- Early initiation of PD in diabetic CKD patients appears to be associated with improved survival.
- Patient age, baseline serum albumin, and the presence of comorbidities such as cerebrovascular disease and cardiac failure significantly impact survival outcomes.
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.
Material And 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.
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