Comparing The Differences Of Prognosis Between Hemodialysis And Peritoneal Dialysis In Patients With Diabetes And End-stage Renal Disease

Objective:As the most common renal replacement therapy(RRT)modalities for end-stage renal disease(ESRD),hemodialysis(HD)and peritoneal dialysis(PD)have both advantages and disadvantages.It is still a contentious problem that the differences of impact on prognosis when choosing HD or PD as first dialysis modality for patients with diabetes.The purpose of this study was to investigate the differences in survival rates of these patients under HD or PD,and to find potential factors which may affect patients’ prognosis.Methods: This study included patients with diabetes and end-stage renal disease who started dialysis at The Second Affiliated Hospital of Soochow University between January 1 2007 and March 31 2016 for a retrospective analysis.The data collected included dialysis modality,sex,age,body mass index(BMI),charlson comorbidity index(CCI),endpoint,laboratory data in stable phase of dialysis.The Kaplan-Meier was used to analysis the survival between HD group and PD group.A Log-rank test was used for significance analysis to compare the prognosis of patients under HD or PD;Calculating hazard ratio(HR)using COX regression analysis to find other potential factors which may affect patients’ prognosis besides dialysis modalities.Statistical analysis was performed using SPSS for Windows,version 22.0(SPSS Inc.Chicago,IL,USA),and P≤0.05 was considered statistical significance.Results: A total of 146 diabetic patients were included,divided into groups of HD(n=63)and PD(n=83).(1)Compared to the HD group,the PD group had a lower ALB.The difference was statistically significant(P<0.001);(2)Using Kaplan-Meier to calculate the 1-year,3-year,5-year and 7-year survival rates of the patients in the HD group were 73%、35%、16% and 6%,respectively,and these rates in the PD group were 82%、53%、16% and 2%,respectively.The differences in the survival rates between the two groups were not statistically significant(P=0.405);(3)The result of univariate COX regression analysis showed that age,white blood cell(WBC),low-density lipoprotein(LDL),albumin(ALB),serum total calcium(Ca)were related to patients’ prognosis;(4)The multivariate Cox regression analysis indicated that only age(HR=1.043,P<0.001)and ALB(HR=0.941,P=0.003)were associated with patients’ prognosis;(5)More patients died from cardiac-cerebral vascular disease(47%),out of dialysis(17%),infection(13%)in HD group,but cardiac-cerebral vascular disease(34%),infection(25%),malnutrition(9%)in PD group.The difference of cause-of-death structure between the two groups was not statistically significant(P=0.498).Conclusion: In patients with diabetes and end-stage renal disease:(1)we therefore found no evidence-based arguments in favour or against a particular modality as first choice treatment;(2)Older age was the independent risk factor,but higher ALB was the preventive factors on the contrary affecting survival rate;(3)The proportionate mortality ratio(PMR)of HD group and PD group did not have significant differences.