Published online Oct 15, 2020. doi: 10.4239/wjd.v11.i10.435
Peer-review started: June 27, 2020
First decision: July 30, 2020
Revised: August 9, 2020
Accepted: September 8, 2020
Article in press: September 8, 2020
Published online: October 15, 2020
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 (n = 214) and 692 episodes occurred in the non-DM group (n = 395). The rates of abdominal pain and fever were similar in the two groups (P > 0.05). The DM group had more infections with coagulase-negative Staphylococcus and less infections with Escherichia coli (E. coli) as compared to the non-DM group (P < 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 (P > 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 (P < 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, P < 0.05), but did not predict the occurrence of technical failure (P > 0.05).
PDAP patients with diabetes have similar symptomology and are predisposed to coagulase-negative Staphylococcus but not E. coli infection compared those without. Diabetes is associated with higher all-cause mortality but not therapeutic outcomes of PDAP.
Core Tip: We for the first time confirmed that the symptoms of peritoneal dialysis-associated peritonitis in the diabetes mellitus group were the same as those in the non-diabetes mellitus group. This is the first multicenter retrospective cohort study to examine the relationship between diabetes mellitus and long-term outcome in peritoneal dialysis-associated peritonitis patients. It is also the first study to analyze the profile of distribution of pathogenic organisms and response of peritoneal dialysis-associated peritonitis to medical management in the subset of end-stage renal disease patients with diabetes mellitus. We found that diabetes mellitus was inclined to infection with coagulase-negative Staphylococcus but not Escherichia coli. Diabetes mellitus was associated with higher all-cause mortality but not with adverse therapeutic outcome of peritoneal dialysis-associated peritonitis.