Cheng SY, Yang LM, Sun ZS, Zhang XX, Zhu XY, Meng LF, Guo SZ, Zhuang XH, Luo P, Cui WP. Risk factors for mortality within 6 mo in patients with diabetes undergoing urgent-start peritoneal dialysis: A multicenter retrospective cohort study. World J Diabetes 2022; 13(4): 376-386 [PMID: 35582665 DOI: 10.4239/wjd.v13.i4.376]
Corresponding Author of This Article
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
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
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Cheng SY, Yang LM, Sun ZS, Zhang XX, Zhu XY, Meng LF, Guo SZ, Zhuang XH, Luo P, Cui WP. Risk factors for mortality within 6 mo in patients with diabetes undergoing urgent-start peritoneal dialysis: A multicenter retrospective cohort study. World J Diabetes 2022; 13(4): 376-386 [PMID: 35582665 DOI: 10.4239/wjd.v13.i4.376]
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 byJilin 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 Processing time: 156 Days and 9.4 Hours
Abstract
BACKGROUND
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.
AIM
To identify risk factors for mortality during high-risk periods in patients with diabetes undergoing USPD.
METHODS
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.
RESULTS
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; P < 0.001), lower baseline serum creatinine level (HR: 0.727; 95%CI: 0.614-0.860; P < 0.001), higher baseline serum phosphorus level (HR: 3.162; 95%CI: 1.848-5.409; P < 0.001), and baseline NYHA class III-IV (HR: 2.148; 95%CI: 1.063-4.340; P = 0.033). Independent risk factors for mortality after 6 mo were advanced age (HR: 1.246; 95%CI: 1.033-1.504; P = 0.022) and baseline NYHA class III-IV (HR: 2.015; 95%CI: 1.298-3.130; P = 0.002).
CONCLUSION
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.
Core Tip: The first 6 mo after the initiation of urgent-start peritoneal dialysis is a high-risk period. We identified the following as risk factors for mortality within the first 6 mo in urgent-start peritoneal dialysis recipients with diabetes: Advanced age, lower baseline serum creatinine level, higher baseline phosphorus level, and baseline New York Heart Association class III-IV.
