ABSTRACT
Objective To explore the risk factors and characteristics in patients with peritoneal dialysis who died in different periods.Methods The clinical data of new peritoneal dialysis patients in the Department of Nephrology and Peritoneal Dialysis Center of the First Affiliated Hospital of Nanchang University from November 1,2005 to February 28,2017 was retrospectively analyzed.The patients were divided into two groups according to the time of death:those who died within one year and died after one year.The risk factors of mortality between the two groups were analyzed by Cox regression model.Results A total of 997 patients were enrolled and 244 patients died.There were 69 patients (28.3％) died within one year and 175 patients (71.7％) died after one year.Cardiovascular and cerebrovascular disease was the dominating reason of death in both groups,accounting for 59.4％ (died within one year group) and 51.4％ (died after one year group) respectively.Cox regression analysis showed that for died within one year group,old age (HR=1.035,95％ CI:1.016-1.055,P＜ 0.001),low blood total calcium (HR=0.167,95％ CI:0.053-0.529,P=0.002),low albumin (HR=0.899,95％CI:0.856-0.943,P ＜ 0.001) and low apolipoprotein A1 (HR=0.274,95％CI:0.095-0.789,P=0.016) were risk factors associated with mortality.However,for died after one year group,old age (HR=1.053,95％CI:1.038-1.069,P ＜ 0.001),combined with diabetes (HR=2.181,95％CI:1.445-3.291,P ＜ 0.001) and hypertriglyceride (HR=l.204,95％CI:1.065-1.362,P=0.003) were risk factors associated with mortality.Conclusions The risk factors of mortality for peritoneal dialysis patients of different periods were not exactly the same.For died within one year patients,old age,low blood total calcium,low albumin and low apolipoprotein A1 were independent risk factors for mortality.However,for died after one year patients,old age,combined with diabetes,and high triglycerides were independent risk factors for mortality.
ABSTRACT
Objective To investigate the risk factors of all-cause mortality in diabetic patients on peritoneal dialysis (PD).Methods As a single-center retrospective cohort study,all incident PD patients who were catheterized at the First Affiliated Hospital of Nanchang University between November 1,2005 and February 28,2017 were included.Patients were divided into diabetes mellitus group (DM group) and non-diabetes mellitus group (NDM group).Outcomes were analyzed by Kaplan-Meier method.Multivariate Cox proportional hazards models were utilized to assess the risk factors of all-cause mortality.Results A total of 977 patients were enrolled.Compared with NDM group,patients in DM group were older (47.5±14.4 vs 59.3±11.3,P ＜ 0.01),had more cardiovascular disease (CVD) (7.5％ vs 20.3％,P ＜ 0.01),higher levels of serum hemoglobin (78.2±17.2 vs 82.3±14.6g/L,P ＜ 0.01),and lower levels of serum albumin (36.1±5.0 vs 32.7±5.6 g/L,P ＜ 0.01).The one-,three-and five-year patient survival rates of DM and NDM group were 89.7％,56.0％,31.9％ and 94.7％,81.3％,67.4％,respectively.Survival rate was significantly lower in DM group than in NDM group (x2=63.51,P ＜ 0.01).Stratified analysis showed that DM group had significant lower survival rate than NDM group in patients younger than 70 years old (x2=73.35,P ＜ 0.01),while survival rate was similar between the two groups patients older than 70 years old (x2=0.003,P=0.96).Multivariate Cox proportional hazards model analysis showed that DM (HR:1.74,95％CI:1.27-2.38,P ＜ 0.01),age (HR:1.05,95％CI:1.04-1.06,P ＜ 0.01),leukocyte (HR:1.06,95％CI:1.00-1.12,P=0.04) and triglyceride (HR:1.19,95％CI:1.07-1.32,P ＜ 0.01) were all independent risk factors for all-cause mortality of PD patients.However,age (HR:1.05,95％CI:1.04-1.07,P＜ 0.01) and alkaline phosphatase (HR:1.01,95％ CI:1.00-1.01,P=0.02) were independent risk factors for all-cause mortality of diabetic patients.Conclusions Long-term survival rate was lower in diabetic PD patients than in non-diabetic PD patients.DM,age,leukocyte and triglyceride were independent risk factors of mortality in PD patients.Age and alkaline phosphatase were independent risk factors of mortality in diabetic patients.