Peritoneal Dialysis in Diabetic Patients

Bertoli, M; Bonfante, Luciana; Gambaro, Giovanni; Cara, M; Virgilio, Bice; D’Angelo, Angela

doi:10.1159/000060060

Cited by 4 publications

(5 citation statements)

References 14 publications

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“…In economically advanced countries, < 4 dextrose exchanges per day is a prescription most often seen in those patients who are starting dialysis, administered as an incremental prescription that increases over time (68)(69)(70)(71). Observational evidence suggests that incremental PD can provide adequate dialysis in those with sufficient residual kidney function (72)(73)(74)(75).…”

Section: Discussionmentioning

confidence: 99%

Number of Daily Peritoneal Dialysis Exchanges and Mortality Risk in a Chinese Population

Chen

et al. 2018

Perit Dial Int

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Background: We report outcomes on ≥ 4 compared with < 4 exchanges/day in a Chinese cohort on continuous ambulatory peritoneal dialysis (CAPD). ♦ Methods: Data were sourced from the Baxter (China) Investment Co. Ltd Patient Support Program database, comprising an inception cohort commencing CAPD between 1 January 2005 and 13 August 2015. We used cause-specific Cox proportional hazards and Fine-Gray competing risks (kidney transplantation, change to hemodialysis) models to estimate mortality risk on ≥ 4 compared with < 4 exchanges/day. We matched or adjusted for age, gender, employment, insurance, primary renal disease, size of CAPD program, year of dialysis inception, and treatment center. ♦ Results: We modeled 100,022 subjects from 1,177 centers over 239,876 patient-years. Of these subjects, 43,185 received < 4 exchanges/day and 56,837 ≥ 4 exchanges/day. The proportion of patients on < 4 exchanges/day varied widely between centers. Those on < 4 exchanges/day were significantly older, more often female, of unknown employment, and from rural China. In the various models, ≥ 4 exchanges/day was associated with a significantly lower risk of death by 30% -35% compared with < 4 exchanges/day. This beneficial effect was greatest in younger and rural patients. ♦ Conclusions: In this Chinese CAPD cohort, ≥ 4 exchanges/day was associated with significantly lower mortality risk than < 4 exchanges/day. Analyses are limited by residual confounding from unavailability of important prognostic covariates (e.g., comorbidity, socioeconomic factors) and data on residual renal function, peritoneal clearance, and transport status with which to judge the clinical appropriateness of CAPD prescription. Nonetheless, our study indicates this area as a high priority for further detailed study.

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Section: Discussionmentioning

confidence: 99%

Number of Daily Peritoneal Dialysis Exchanges and Mortality Risk in a Chinese Population

Chen

et al. 2018

Perit Dial Int

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“…The two groups displayed no significant differences in membrane characteristics: high transporters in PET (%): ER vs LR 9/16 (56.25%) vs 22/36 (61.11%). Pre-existing cardiovascular disease is thought to be the major risk factor of dialysis mortality (22). The two groups displayed no significant differences in prevalence of hypertension [ER vs LR 13/16 (81.3%) vs 30/36 (83.3%)] or ischemic heart disease [ER vs LR 4/16 (25.0%) vs 8/36 (22.2%)] just before starting PD.…”

Section: Resultsmentioning

confidence: 99%

“…Diabetic patients also have constituted one of the major populations of chronic peritoneal dialysis (PD) patients since the maintenance PD program was introduced (22). Recent studies indicate that PD is associated with preserving better residual renal function (RRF) (23,24).…”

mentioning

confidence: 99%

Improvement in Clinical Outcome by Early Nephrology Referral in Type Ii Diabetics on Maintenance Peritoneal Dialysis

Lin

Chang

et al. 2003

Perit Dial Int

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← Objectives To evaluate the influence of early nephrology referral on clinical outcome in type II diabetes mellitus patients on maintenance peritoneal dialysis (PD). ← Design This is a retrospective study in a single University Hospital in Taiwan. ← Patients This study analyzed the type II diabetic patients entering our PD program from February 1988 to June 2000. Patients that were presented to a nephrologist more than 6 months before starting dialysis were defined as early referrals (ER). Patients were considered late referrals (LR) if they were transferred to the nephrology department within 6 months before initial dialysis. ← Main Outcome Measures Patient survival and technique survival curves were derived from Kaplan–Meier analysis and were compared using the Cox–Mantel log rank test. Covariates were analyzed with Cox proportional hazards model. ← Results 52 type II diabetic patients were enrolled in this study: 16 in the ER group and 36 in the LR group. Patient survival was better in the ER group than in the LR group {relative risks [exp(coef)] 0.42; 95% confidence interval 0.152 – 0.666; p < 0.05}. The improved survival in the ER group was independent of age at dialysis, good glycemic control, and residual renal function, as indicated in the multivariate analysis with stepwise regression by Cox proportional hazards model. The ER group was also associated with better technique survival. ← Conclusions These results suggest that early nephrology referral before initiating dialysis is associated with improved long-term clinical outcome in type II diabetics on maintenance PD.

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“…Pre-existing cardiovascular disease is thought to be the major risk factor of dialysis mortality. [17] The early and late referral groups displayed no significant differences in incidence of predialysis hypertension (ER vs. LR: 26/53; 49.1% vs. 30/62; 48.4%) and ischemic heart disease (ER vs. LR: 16/53; 30.2% vs. 18/62; 29.0%). The biochemical parameters were also reviewed in both groups (Table 1).…”

Section: Clinical Characteristics Of Diabetic Patientsmentioning

confidence: 86%

“…Previous studies had shown that diabetic patients with pre-dialysis poor glycemic control, [3,12] malnutrition status, and cardiovascular disease are associated with increased morbidity and shortened survival. [13] However, it is still unknown if the early referral before starting hemodialysis will affect the long-turn outcome of chronic dialysis therapy in these specific patients ''DM.'' In addition, our recent study also has shown early nephrology referral in type II diabetics on maintenance peritoneal dialysis will significantly improvement of clinical outcome.…”

Section: Introductionmentioning

confidence: 99%

Improvement of Clinical Outcome by Early Nephrology Referral in Type II Diabetics on Hemodialysis

Lin

Hsu

et al. 2003

Renal Failure

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We demonstrate that the time of referral before starting dialysis is a predictor of survival for type II diabetics on HD. Patients with early referral are associated with longer survival. The beneficial effect might be associated with the timely initiation of the chronic HD program. These results suggest that early referral before dialysis is important in determining the long-term prognosis in type II diabetics on HD.

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Peritoneal Dialysis in Diabetic Patients

Cited by 4 publications

References 14 publications

Number of Daily Peritoneal Dialysis Exchanges and Mortality Risk in a Chinese Population

Number of Daily Peritoneal Dialysis Exchanges and Mortality Risk in a Chinese Population

Improvement in Clinical Outcome by Early Nephrology Referral in Type Ii Diabetics on Maintenance Peritoneal Dialysis

Improvement of Clinical Outcome by Early Nephrology Referral in Type II Diabetics on Hemodialysis

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