Outcomes of diabetic patients undergoing peritoneal dialysis in the French Language Peritoneal Dialysis Registry

Diabetes is the leading cause of end-stage kidney disease (ESKD) worldwide. In particular, whether diabetes has a negative effect on the risk of transfer to haemodialysis (HD) remains controversial. This study was conducted to provide updated data on outcomes of patients with diabetes on peritoneal dialysis (PD).

This was a retrospective cohort study using data from the French Language Peritoneal Dialysis Registry, including patients starting PD between 2008 and 2018; the end of the study was 31 December 2021. Cox and Fine-Gray models examined associations between diabetes and mortality, transfer to HD, a composite outcome of death and HD transfer and kidney transplantation. In addition, the causes of transfer to HD were analysed separately. Mediation analyses were performed to assess the indirect effects of early peritonitis and assisted PD on HD transfer.

Of 10 412 PD patients, 3473 (33%) were diabetics. Diabetes was associated with an increased risk of HD transfer {cause-specific hazard ratio [cs-HR] 1.69 [95% confidence interval (CI) 1.36-2.11]}, death [cs-HR 1.32 (95% CI 1.21-1.43)] and the composite outcome [cs-HR 1.23 (95% CI 1.15-1.31)] in Cox and Fine-Gray models [HD transfer subdistribution HR (sd-HR) 1.18 (95% CI 1.07-1.31); death sd-HR 1.25 (95% CI 1.15-1.35)]. Diabetic patients were less likely to receive a kidney transplant [cs-HR 0.52 (95% C: 0.41-0.66); sd-HR 0.44 (95% CI 0.35-0.56)]. At a 5% false discovery rate, diabetes was significantly associated with an increased risk of transfer to HD due to inadequate dialysis, other PD-related causes and non-PD-related causes. Mediation analyses showed no significant indirect effects via early peritonitis or assisted PD.

Diabetes has a higher risk of transfer to HD that was not explained by early peritonitis or not being assisted. Diabetic PD patients have a greater mortality risk and lower access to transplantation.