Cheng Si-Yu, Yang Li-Ming, Sun Zhan-Shan, Zhang Xiao-Xuan, Zhu Xue-Yan, Meng Ling-Fei, Guo Shi-Zheng, 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. 2022 Apr 15;13(4):376-386. doi: 10.4239/wjd.v13.i4.376.
The risk of early mortality of patients who start dialysis urgently is high; however, in patients with diabetes undergoing urgent-start peritoneal dialysis (USPD), the risk of, and risk factors for, early mortality are unknown.
To identify risk factors for mortality during high-risk periods in patients with diabetes undergoing USPD.
This retrospective cohort study enrolled 568 patients with diabetes, aged ≥ 18 years, who underwent USPD at one of five Chinese centers between 2013 and 2019. We divided the follow-up period into two survival phases: The first 6 mo of USPD therapy and the months thereafter. We compared demographic and baseline clinical data of living and deceased patients during each period. Kaplan-Meier survival curves were generated for all-cause mortality according to the New York Heart Association (NYHA) classification. A multivariate Cox proportional hazard regression model was used to identify risk factors for mortality within the first 6 mo and after 6 mo of USPD.
Forty-one patients died within the first 6 mo, accounting for the highest proportion of mortalities (26.62%) during the entire follow-up period. Cardiovascular disease was the leading cause of mortality within 6 mo (26.83%) and after 6 mo (31.86%). The risk of mortality not only within the first 6 mo but also after the first 6 mo was higher for patients with obvious baseline heart failure symptoms than for those with mild or no heart failure symptoms. Independent risk factors for mortality within the first 6 mo were advanced age [hazard ratio (HR: 1.908; 95%CI: 1.400-2.600; < 0.001), lower baseline serum creatinine level (HR: 0.727; 95%CI: 0.614-0.860; 0.001), higher baseline serum phosphorus level (HR: 3.162; 95%CI: 1.848-5.409; 0.001), and baseline NYHA class III-IV (HR: 2.148; 95%CI: 1.063-4.340; = 0.033). Independent risk factors for mortality after 6 mo were advanced age (HR: 1.246; 95%CI: 1.033-1.504; = 0.022) and baseline NYHA class III-IV (HR: 2.015; 95%CI: 1.298-3.130; = 0.002).
To reduce the risk of mortality within the first 6 mo of USPD in patients with diabetes, controlling the serum phosphorus level and improving cardiac function are recommended.
紧急开始透析的患者早期死亡风险很高；然而，在接受紧急开始腹膜透析（USPD）的糖尿病患者中，早期死亡的风险及危险因素尚不清楚。
确定接受USPD的糖尿病患者在高危期的死亡危险因素。
这项回顾性队列研究纳入了568例年龄≥18岁、于2013年至2019年在中国五个中心之一接受USPD的糖尿病患者。我们将随访期分为两个生存阶段：USPD治疗的前6个月及其后的月份。我们比较了每个阶段存活和死亡患者的人口统计学和基线临床数据。根据纽约心脏协会（NYHA）分类生成全因死亡率的Kaplan-Meier生存曲线。使用多变量Cox比例风险回归模型确定USPD前6个月内及6个月后的死亡危险因素。
41例患者在最初6个月内死亡，占整个随访期死亡人数的最高比例（26.62%）。心血管疾病是6个月内（26.83%）和6个月后（31.86%）的主要死亡原因。基线时有明显心力衰竭症状的患者不仅在最初6个月内而且在最初6个月后的死亡风险均高于轻度或无心力衰竭症状的患者。最初6个月内死亡的独立危险因素为高龄[风险比（HR）：1.908；95%置信区间（CI）：1.400 - 2.600；P < 0.001]、较低的基线血清肌酐水平（HR：0.727；95%CI：0.614 - 0.860；P < 0.001）、较高的基线血清磷水平（HR：3.162；95%CI：1.848 - 5.409；P < 0.001）以及基线NYHA III - IV级（HR：2.148；95%CI：1.063 - 4.340；P = 0.033）。6个月后死亡的独立危险因素为高龄（HR：1.246；95%CI：1.033 - 1.504；P = 0.022）和基线NYHA III - IV级（HR：2.015；95%CI：1.298 - 3.130；P = 0.002）。
为降低糖尿病患者USPD最初6个月内的死亡风险，建议控制血清磷水平并改善心功能。
