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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Risk factors for mortality within 6 mo in patients with diabetes undergoing urgent-start peritoneal dialysis: A multicenter retrospective cohort study
Si-Yu Cheng, Li-Ming Yang, Zhan-Shan Sun, Xiao-Xuan Zhang, Xue-Yan Zhu, Ling-Fei Meng, Shi-Zheng Guo, Xiao-Hua Zhuang, Ping Luo, Wen-Peng Cui
Si-Yu Cheng, Ling-Fei Meng, Shi-Zheng Guo, 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
Zhan-Shan Sun, Department of Nephrology, Xing’anmeng People’s Hospital, Ulan Hot 137400, Inner Mongolia Autonomous Region China
Xiao-Xuan Zhang, Department of Nephrology, Jilin FAW General Hospital, Changchun 130041, Jilin Province, China
Xue-Yan Zhu, Department of Nephrology, Jilin Central Hospital, Jilin 132011, Jilin Province, China
Author contributions: All the authors solely contributed to this paper; Cheng SY analyzed the data and wrote this manuscript; Yang LM, Sun ZS, Zhang XX, and Zhu XY provided the data; Meng LF, Guo SZ, and Zhuang XH collected 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. 2018FP031.
Institutional review board statement: This retrospective study was approved by the Ethics Committee of the Second Hospital of Jilin University (design number, 2020031).
Informed consent statement: The requirement for informed consent was waived owing to the retrospective nature of the study.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at wenpengcui@163.com
STROBE statement: The guidelines of the STROBE statement have been adopted for this study.
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:
https://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: November 9, 2021
Peer-review started: November 9, 2021
First decision: January 12, 2022
Revised: January 20, 2022
Accepted: March 16, 2022
Article in press: March 16, 2022
Published online: April 15, 2022
ARTICLE HIGHLIGHTS
Research background
Many patients with end-stage renal disease have to choose urgent-start peritoneal dialysis (USPD), and patients with diabetes mellitus (DM) who are undergoing USPD have a poorer prognosis than do those without DM. The first 6 mo after the start of urgent dialysis is a high-risk period, and for patients with DM undergoing USPD, we speculate that the mortality risk is high in the first 6 mo after USPD. However, the distribution of mortalities over time and the risk factors for mortality within the first 6 mo in this patient population has not been reported. Thus, it is important to identify the risk factors for mortality within the first 6 mo of USPD initiation in patients with DM.
Research motivation
We hoped to identify the reasons for the poor prognosis of patients with DM undergoing USPD.
Research objectives
The main aim of this study was to identify risk factors for mortality within the first 6 mo in patients with DM undergoing USPD in order to facilitate better management of such patients in clinical practice.
Research methods
In this multicenter, retrospective cohort study, we screened patients with ESRD who underwent USPD at five hospitals. To highlight the specificity of risk factors within the first 6 mo, we divided the follow-up period into two survival phases: the first 6 mo and the months thereafter. We compared the survival rates of patients with different cardiac function classes in each period using Kaplan-Meier curves. The risk factors for mortality during the different periods were analyzed using a Cox proportional hazard regression model.
Research results
We found that the highest proportion (26.62%) of mortalities occurred between 0 and 6 mo. The mortality rate for patients with baseline cardiac function represented by New York Heart Association (NYHA) III-IV was much higher than that for patients without cardiac function limitation, both within the first 6 mo and after 6 mo (all P < 0.05). Increased age (P < 0.001), lower levels of baseline serum creatinine (P < 0.001), higher levels of baseline serum phosphorus (P < 0.001), and NYHA class III-IV at baseline (P = 0.033) were risk factors for mortality within the first 6 mo. The risk factors for mortality after 6 were advanced age (P = 0.022) and baseline NYHA class III-IV (P = 0.002).
Research conclusions
This study suggests the importance of controlling serum phosphorus levels and improving cardiac function for decreasing the mortality risk within the first 6 mo in patients with DM undergoing USPD.
Research perspectives
Further research is needed to build a model to predict the risk of mortality within the first 6 mo in patients with DM undergoing USPD.
