Meng Ling-Fei, Yang Li-Ming, Zhu Xue-Yan, Zhang Xiao-Xuan, Li Xin-Yang, Zhao Jing, Liu Shi-Chen, Zhuang Xiao-Hua, Luo Ping, Cui Wen-Peng
Department of Nephrology, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China.
Department of Nephrology, The First Hospital of Jilin University-the Eastern Division, Changchun 130041, Jilin Province, China.
World J Diabetes. 2020 Oct 15;11(10):435-446. doi: 10.4239/wjd.v11.i10.435.
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.
To compare the clinical features and outcomes of PDAP between patients with DM and those without.
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.
Overall, 373 episodes occurred in the DM group ( = 214) and 692 episodes occurred in the non-DM group ( = 395). The rates of abdominal pain and fever were similar in the two groups ( > 0.05). The DM group had more infections with coagulase-negative Staphylococcus and less infections with () as compared to the non-DM group ( < 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 ( > 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 ( < 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, < 0.05), but did not predict the occurrence of technical failure ( > 0.05).
PDAP patients with diabetes have similar symptomology and are predisposed to coagulase-negative Staphylococcus but not infection compared those without. Diabetes is associated with higher all-cause mortality but not therapeutic outcomes of PDAP.
接受腹膜透析的终末期肾病合并糖尿病患者数量正在增加。腹膜透析相关腹膜炎（PDAP）是腹膜透析的一种严重并发症，可导致腹膜透析技术失败，并增加患者死亡率。此前尚未报道过终末期肾病合并糖尿病患者亚组中PDAP的临床症状特征、致病微生物分布以及药物治疗反应。在糖尿病患者中，PDAP的长期预后结果存在差异。我们推断糖尿病与PDAP患者的不良预后相关。
比较糖尿病患者与非糖尿病患者PDAP的临床特征和预后。
在这项多中心回顾性队列研究中，我们纳入了在研究期间至少发生过一次PDAP的患者。患者的中位随访时间为31.1个月。他们被分为糖尿病组和非糖尿病组。比较两组的临床特征、治疗结果和长期预后。使用多变量逻辑回归分析与PDAP治疗结果相关的危险因素。构建Cox比例风险模型以检验糖尿病对患者生存和技术失败发生率的影响。
总体而言，糖尿病组发生了373次（n = 214），非糖尿病组发生了692次（n = 395）。两组的腹痛和发热发生率相似（P>0.05）。与非糖尿病组相比，糖尿病组凝固酶阴性葡萄球菌感染更多，而大肠杆菌感染更少（P<0.05）。多变量逻辑回归分析显示糖尿病的存在与完全治愈、拔管、PDAP相关死亡或PDAP复发率之间无关联（P>0.05）。糖尿病组患者年龄更大，心血管疾病负担更高，血清白蛋白水平更低，但估计肾小球滤过率更高（P<0.05）。Cox比例风险模型证实糖尿病的存在是全因死亡率的显著预测因素（风险比 = 1.531，95%置信区间：1.091 - 2.148，P<0.05），但不能预测技术失败的发生（P>0.05）。
与非糖尿病患者相比，糖尿病患者发生PDAP时症状相似，易发生凝固酶阴性葡萄球菌感染而非大肠杆菌感染。糖尿病与更高的全因死亡率相关，但与PDAP的治疗结果无关。
