Comparison Of Efficacy And Prognosis Of Peritoneal Dialysis For End-stage Diabetic Kidney Disease And Non-diabetic Kidney Disease

Background: Diabetic kidney disease(DKD)is a renal microvascular disease caused by diabetes mellitus,and it is also one of the important factors inducing end-stage renal disease(ESRD).Peritoneal dialysis(PD)is one of the effective alternative therapies for ESRD at present.In order to better understand the difference of curative effect and prognosis between DKD and non-diabetic kidney disease(NDKD)patients,the clinical indexes and prognosis of PD patients in our department in recent 10 years were analyzed retrospectively.Methods: A total of 150 patients who underwent PD treatment in our department in the past 10 years were selected,including 102 males and 48 females.They were divided into DKD group and NDKD group according to the primary disease,including 56 cases in DKD group and 94 cases in NDKD group.General information and dialysis initiation of the two groups were collected.The clinical indicators,dialysis adequacy,prognosis and other related data at different stages after dialysis were analyzed and compared,the survival curves of the patients who underwent PD treatment were drawn,and the differences in survival rates and the key factors affecting survival rates were analyzed.Results: 1.According to the analysis of the composition of the primary disease,75(50%)cases of chronic glomerulonephritis ranked first,56(37.33%)cases of DKD ranked second,which was consistent with the epidemiological investigation in China.2.After PD treatment,renal anemia was improved,hemoglobin,hematocrit and hemoglobin reaching rate were significantly higher than the baseline value.3.Compared with NDKD group,DKD group was younger,serum creatinine was lower,estimated glomerular filtration rate was higher,serum albumin and blood calcium were lower,suggesting that DKD group entered dialysis earlier and nutritional status was worse than NDKD group;after 12 months of dialysis,there was no significant difference between the two groups in laboratory indicators.4.The levels of blood glucose,glycosylated hemoglobin and vitamin B12 in DKD group were higher than those in NDKD group from the beginning of baseline,but there was no significant difference in blood lipid metabolism.5.The dosage of peritoneal dialysis treatment in DKD group was higher than that in NDKD group from 1 to 12 months after dialysis,and there was no significant difference in ultrafiltration volume of 24 h peritoneal dialysis,but 24 h urine volume in DKD group was less than that in NDKD group at 12 months after dialysis,and the incidence of edema was higher than that in NDKD group,while there was no significant difference in blood pressure level and types of antihypertensive drugs.6.DKD group was more likely to be in inflammatory state,and the incidence of peritoneal dialysis related infectious complications was higher than NDKD group.7.The incidence of cardiovascular and cerebrovascular complications in DKD group was higher than that in NDKD group,and there was no significant difference in the incidence of cardiovascular and cerebrovascular accidents after dialysis compared with NDKD group.8.Cardiovascular and cerebrovascular accident was the first cause of death and infection was the second.There was no significant difference between DKD group and NDKD group in all-cause mortality and cardiovascular and cerebrovascular accident mortality.9.There was no significant difference in technical survival rate and survival rate between DKD group and NDKD group.The survival rate of patients without complications of cardiovascular and cerebrovascular diseases before dialysis was higher than that of patients with complications of cardiovascular and cerebrovascular diseases.After dialysis the survival rate of patients without cardiovascular and cerebrovascular accidents was significantly higher than that of patients with cardiovascular and cerebrovascular accidents.Further Cox regression multivariate analysis showed that age,blood glucose and whether there was cardio cerebral accident were independent risk factors for survival rate of PD patients.Conclusions: Comprehensive intervention should be given to the patients who underwent PD treatment in the diagnosis and treatment process,especially DKD patients,including: correct malnutrition,prevent infection, correct anemia,regulate blood glucose and lipid,control blood pressure,fully dialysis,reduce the incidence of cardiovascular and cerebrovascular accidents,and further improve the survival rate.