Published online Apr 15, 2022. doi: 10.4239/wjd.v13.i4.376
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
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.
We hoped to identify the reasons for the poor prognosis of patients with DM undergoing USPD.
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.
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.
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).
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.
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.