Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Oct 15, 2020; 11(10): 435-446
Published online Oct 15, 2020. doi: 10.4239/wjd.v11.i10.435
Comparison of clinical features and outcomes in peritoneal dialysis-associated peritonitis patients with and without diabetes: A multicenter retrospective cohort study
Ling-Fei Meng, Li-Ming Yang, Xue-Yan Zhu, Xiao-Xuan Zhang, Xin-Yang Li, Jing Zhao, Shi-Chen Liu, Xiao-Hua Zhuang, Ping Luo, Wen-Peng Cui
Ling-Fei Meng, Xin-Yang Li, Jing Zhao, Shi-Chen Liu, Xiao-Hua Zhuang, Ping Luo, Wen-Peng Cui, Department of Nephrology, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
Li-Ming Yang, Department of Nephrology, The First Hospital of Jilin University-the Eastern Division, Changchun 130041, Jilin Province, China
Xue-Yan Zhu, Department of Nephrology, Jilin Central Hospital, Jilin 132011, Jilin Province, China
Xiao-Xuan Zhang, Department of Nephrology, Jilin FAW General Hospital, Changchun 130041, Jilin Province, China
Author contributions: Meng LF analyzed the data and wrote this manuscript; Li XY, Zhao J, Liu SC, and Zhuang XH collected the data; Yang LM, Zhu XY, and Zhang XX provided the data; Luo P organized the study; Cui WP designed this study and reviewed this manuscript.
Supported by Jilin Province Health and Technology Innovation Development Program Funded Project, No. 2017Q024 and No. 2018FP031.
Institutional review board statement: The study was reviewed and approved by the Second Hospital of Jilin University Institutional Review Board (No. 2020026).
Informed consent statement: Individual informed consent was waived given that the study was retrospective and non-interventional by design.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
Data sharing statement: The original dataset available from the corresponding author at wenpengcui@163.com. Consent was not obtained but the presented data are anonymized and risk of identification is low.
STROBE statement: The authors have read the STROBE Statement checklist of items, and the manuscript was prepared and revised according to the STROBE Statement checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wen-Peng Cui, MD, PhD, Doctor, Professor, Department of Nephrology, The Second Hospital of Jilin University, No. 218 Ziqiang Street, Changchun 130041, Jilin Province, China. wenpengcui@163.com
Received: June 27, 2020
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
Processing time: 109 Days and 1.7 Hours
Abstract
BACKGROUND

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.

AIM

To compare the clinical features and outcomes of PDAP between patients with DM and those without.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

Keywords: Diabetes mellitus; Mortality; Peritoneal dialysis; Peritoneal dialysis-associated peritonitis; Technical failure

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.