Comparison of clinical features and outcomes in peritoneal dialysis-associated peritonitis patients with and without diabetes: A multicenter retrospective cohort study

Abstract

Background: The number of end-stage renal disease patients with diabetes mellitus (DM) who are undergoing peritoneal dialysis is increasing. Peritoneal dialysis-associated peritonitis (PDAP) is a serious complication of peritoneal dialysis leading to technical failure and increased mortality in patients undergoing peritoneal dialysis. The profile of clinical symptoms, distribution of pathogenic organisms, and response of PDAP to medical management in the subset of end-stage renal disease patients with DM have not been reported previously. Discrepant results have been found in long-term prognostic outcomes of PDAP in patients with DM. We inferred that DM is associated with bad outcomes in PDAP patients.

Aim: To compare the clinical features and outcomes of PDAP between patients with DM and those without.

Methods: In this multicenter retrospective cohort study, we enrolled patients who had at least one episode of PDAP during the study period. The patients were followed for a median of 31.1 mo. They were divided into a DM group and a non-DM group. Clinical features, therapeutic outcomes, and long-term prognostic outcomes were compared between the two groups. Risk factors associated with therapeutic outcomes of PDAP were analyzed using multivariable logistic regression. A Cox proportional hazards model was constructed to examine the influence of DM on patient survival and incidence of technical failure.

Results: Overall, 373 episodes occurred in the DM group (n = 214) and 692 episodes occurred in the non-DM group (n = 395). The rates of abdominal pain and fever were similar in the two groups (P > 0.05). The DM group had more infections with coagulase-negative Staphylococcus and less infections with Escherichia coli (E. coli) as compared to the non-DM group (P < 0.05). Multivariate logistic regression analysis revealed no association between the presence of diabetes and rates of complete cure, catheter removal, PDAP-related death, or relapse of PDAP (P > 0.05). Patients in the DM group were older and had a higher burden of cardiovascular disease, with lower level of serum albumin, but a higher estimated glomerular filtration rate (P < 0.05). Cox proportional hazards model confirmed that the presence of diabetes was a significant predictor of all-cause mortality (hazard ratio = 1.531, 95% confidence interval: 1.091-2.148, P < 0.05), but did not predict the occurrence of technical failure (P > 0.05).

Conclusion: PDAP patients with diabetes have similar symptomology and are predisposed to coagulase-negative Staphylococcus but not E. coli infection compared those without. Diabetes is associated with higher all-cause mortality but not therapeutic outcomes of PDAP.

Keywords: Diabetes mellitus; Mortality; Peritoneal dialysis; Peritoneal dialysis-associated peritonitis; Technical failure.

Figure 1

Flowchart of cohort establishment. PDAP: Peritoneal dialysis-associated peritonitis; DM: Diabetes mellitus.

Figure 2

Association between diabetes mellitus and therapeutic outcomes of peritoneal dialysis-associated peritonitis. A: Therapeutic outcomes of peritoneal dialysis-associated peritonitis (PDAP), including complete cure, catheter removal, PDAP-related death, and relapse of PDAP, between the two groups; B: Multivariable logistic regression analysis of relationship between diabetes mellitus and therapeutic outcomes of PDAP. Covariates with P < 0.05 in the univariate model and conventional confounders related to therapeutic outcomes (history of diabetes mellitus, age, gender, number of peritonitis episodes, history of cardiovascular diseases, basic hemoglobin, albumin, and estimated glomerular filtration rate) were included in the multivariate regression model. NS: Not significant; PDAP: Peritoneal dialysis-associated peritonitis; DM: Diabetes mellitus; OR: Odds ratio.

Figure 3

Association between diabetes mellitus and long-term prognostic outcomes of peritoneal dialysis-associated peritonitis. A: Long-term prognostic outcomes of PDAP, including all-cause death, technique failure, and on dialysis between the two groups; B and C: Kaplan-Meier analysis of cumulative patient survival and technique survival according to diabetes mellitus (DM); D: Cox regression analysis of relationship between DM and long-term prognostic outcomes. Covariates with P < 0.05 in the univariate model and conventional confounders related to long-term prognostic outcomes (history of DM, age, gender, times of peritonitis episodes, history of cardiovascular diseases, basic hemoglobin, albumin, and estimated glomerular filtration rate) were included in the multivariate regression model. ^aP < 0.05, compared between DM group and non-DM group. DM: Diabetes mellitus; HR: Hazard ratio.