Risk factors for mortality within 6 mo in patients with diabetes undergoing urgent-start peritoneal dialysis: A multicenter retrospective cohort study

• Published in: World journal of diabetes 2022-04, Vol.13 (4), p.376-386
• Main Authors: Cheng, Si-Yu, Yang, Li-Ming, Sun, Zhan-Shan, Zhang, Xiao-Xuan, Zhu, Xue-Yan, Meng, Ling-Fei, Guo, Shi-Zheng, Zhuang, Xiao-Hua, Luo, Ping, Cui, Wen-Peng
• Format: Article
• Language: English
• Subjects: Retrospective Cohort Study
• ISSN: 1948-9358; 1948-9358
• DOI: 10.4239/wjd.v13.i4.376

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. To identify risk factors for mortality during high-risk periods in patients with diabetes undergoing USPD. 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. 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; < 0.001), lower baseline serum creatinine level (HR: 0.727; 95%CI: 0.614-0.860; 0.001), higher baseline serum phosphorus level (HR: 3.162; 95%CI: 1.848-5.409; 0.001), and baseline NYHA class III-IV (HR: 2.148; 95%CI: 1.063-4.340; = 0.033). Independent risk factors for mortality after 6 mo were advanced age (HR: 1.246; 95%CI: 1.033-1.504; = 0.022) and baseline NYHA class III-IV (HR: 2.015; 95%CI: 1.298-3.130; = 0.002). 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.