Analysis Of Clinical Features And Outcome Of Peritoneal Dialysis Patients With End-stage Diabetic Nephropathy

Objective:To compare the clinical characteristics,survival rate,technical survival rate of patients with end-stage diabetic nephropathy(DN)and non-diabetic nephropathy(NDN)on peritoneal dialysis(PD)and their affecting factors,in order to increase the awareness of the feature in the end-stage DN patients on the PD,guide clinical treatment and improve the survival of DN patients on the PD,so that could improve their long-term prognosis.Method:The clinical data were collected from the patients who initiated PD in the PD Center of the Second Hospital of Jilin University from January 2012 and December 2017.The patients were divided into the group of DN and NDN and their clinical data were analyzed retrospectively,including general indicators: gender,age of dialysis,body mass index,24-hour urine output,etc.;biochemical indicators: laboratory indicators on the first dialysis,nutritional indicators on the dialysis for six months,one year,two years,and three years,solute clearance Indicators,dialysis adequacy indicators,and PD complications.By comparing the contents of above-mentioned,the primary disease of end-stage renal disease was analyzed for the effect of clinical treatment of PD.Results:1.The primary disease of end-stage renal disease and the general situationThere were 258 PD patients were included in the study,96(37.21%)of them were DN and 162(63.79%)were NDN.The primary diseases in order were: diabetes,chronic glomerular nephritis,hypertension-related renal damage,tubulointerstitial damage,other and polycystic kidneys.The age,weight,and body mass index of the DN group were higher than those of the non-DN group.2.Biochemical indicatorsHemoglobin in the DN group was higher than that in the NDN group before dialysis,and the levels in the DN group were comparable after dialysis.Serum albumin and prealbumin were lower in the DN group than in the NDN group before PD and after dialysis for 6 months,1 year,and 2 years.After 3 years of dialysis,the levels were comparable.Toxin-related indicators of PD including urea nitrogen,creatinine,cystatin,phosphorus,and parathyroid hormone were higher in the DN group than in the NDN group,there is no difference between two groups after PD.3.Urine volume,residual renal function and dialysis adequacy indexBefore PD and 6 months after dialysis,urine volume of DN group was higher than NDN group;before dialysis and 6 months and 1 year on PD,DN group was higher NDN group in residual renal function.6 months and 1 year after PD,the peritoneal dialysis solution concentration,high concentration of the peritoneal dialysis solution and volume of the ultrafiltration was higher in the DN group than in the NDN group.4.Type of the peritoneal transportThe percentage of peritoneal transport were low,low average,high average,and high,the rate was 9.33%,28.00%,41.33%,and 21.33% respectively in the DN group,and in the NDN group,they were 8.46%,39.23%,40.00% and 12.31% respectively.There was no difference between the two groups(P>0.05).5.ComplicationsThe prevalence of peritonitis,pulmonary infection,urinary tract infection,and cardiovascular disease in DN group was higher than that in NDN group(P<0.05).The parathyroid hyperfunction in NDN group was higher than that in DN group,and the difference was statistically significant(P < 0.05).6.The outcome of the diseaseAfter 3 years of follow-up or the deadline,the proportion of patients who continued PD,death,hemodialysis,lost follow-up,and renal transplantation in the DN group were 69.79%,16.67%,9.38%,3.13%,and 1.04% respectively;the NDN group was 77.78%,10.49%,and 6.79%,1.85%,3.09% respectively.There was no difference between the two groups(P> 0.05).7.The age of PDThe average duration of PD was 22.85±14.89 months,21.81±14.90 months in the DN group,and 23.77±14.83 months in the NDN group.There was no statistical difference between the two groups(P>0.05).8.Survival analysis:(1)Kaplan-Meier univariate analysis showed that there was no difference on survival rate and technical survival rate between DN group and NDN group during the follow-up(P>0.05).(2)Anlysis on the survival risk factors: In the multivariate COX regression analysis,age(HR=1.052,95% CI: 1.023-1.083,P=0.000),serum ferritin(HR =1.002,95%CI:1.001-1.003,P=0.004)were independent risk factors for the survival of patients with PD,age(HR=1.061,95% CI: 1.010-1.115,P=0.018)and serum ferritin(HR=1.003,95%CI:1.001-1.005,P=0.006)were risk factors for the survival of PD patients in DN group;blood glucose(HR=1.236,95%CI:1.045-1.462,P=0.013)and cerebrovascular disease(HR=6.079,95% CI: 2.156-17.138,P=0.001)were the risk factors affecting the survival of NDN patients.(3)Anlysis on the technical survival risk factors: Using the multivariate COX regression analysis,BNP(HR=1.00038,95% CI: 1.0002-1.001,P=0.045),eGFR(HR=0.835,95% CI: 0.746-0.917,P=0.002)and peritonitis(HR=3.901,95% CI:1.555-9781,P=0.004)were risk factors affecting the PD patient’s technical survival rate;age(HR=1.152,95%CI:1.045-1.270,P=0.002),BNP(HR=1.001,95%CI:1.0005-1.006,P=0.001),eGFR(HR=0.900,95%CI: 0.846-0.965 P=0.004)and high peritoneal transport(HR=8.396,95%CI:1.336-52.785,P=0.023)are risk factors for PD technical survival in DN patients;peritonitis(HR=5.814,95%CI:1.701-19.875,P=0.005)is a risk factor affecting the technical survival rate of patients with NDN.Conclusion:1.Among all primary diseases of PD patients in our PD center,DN was in the first place,followed by chronic glomerular nephritis.2.With the extension of dialysis time,malnutrition status of DN patients gradually improved,and the residual renal function decreased gradually.The prevalence of peritonitis,pulmonary and urinary tract infections,and combined cardiovascular disease in patients with DN is higher than that of patients with NDN,but the incidence of hyperparathyroidism is lower than that of patients with NDN in our centre.3.There was no difference on survival rate between DN group and NDN group.The risk factors for mortality in PD patients of our study centre are age and serum ferritin,the risk factors for DN were age and serum ferritin and risk factors for NDN patients were blood glucose and cerebrovascular disease.4.There was no difference on technical survival rate between DN group and NDN group.The risk factors affecting the technical survival rate of PD patients in this study are age,BNP,eGFR,and peritonitis.The risk factors in DN group are age,BNP,eGFR,and high peritoneal transport;peritonitis is the risk factor of NDN patients in technical survival rate.