Effects of diabetes or new-onset hyperglycemia on prognosis in peritoneal dialysis patients

Objective To explore the effects of diabetes mellitus(DM) or newly-onset fasting plasma glucose(FPG) elevation after peritoneal dialysis(PD) on the prognosis of PD patients and analyze the proportion and predictors of newly-onset FPG elevation after PD therapy.Methods From March 2009 to October 2021,retrospective review was conducted for baseline profiles and laboratory data of 474 adult patients on PD.They were divided into two groups of diabetic(n=129) and non-diabetic(n=345) according to the presence or absence of DM at the start of PD.Group B was assigned into two subgroups according to whether or not newly-onset FPG elevation(results of at least 2 re-examinations showing FPG ≥7.0 mmol/L) occurred after initialing PD:Group Bc:elevated FPG group,Group Bd:non-elevated FPG group.Differences between groups and subgroups were compared by Kaplan-Meier survival curves and Cox regression model for examining potential predictors of mortality and new-onset elevated fasting glucose in PD patients.Results Cumulative survival rate was significantly lower in diabetic group than that in non-diabetic group(Log-rank=25.756,P＜0.001).However,inter-group difference in technical survival was insignificant(Log-rank=0.061,P=0.805).Multivariate Cox regression analysis revealed that DM(HR=1.728,95%CI:1.110-2.690,P=0.016),coronary heart disease(HR=2.793,95%CI:1.518-5.140,P=0.001),lower parathyroid hormone(PTH)(HR=0.360,95%CI:0.235-0.551,P＜0.001) and lower hemoglobin(Hb)(HR=0.559,95%CI:0.373-0.838,P=0.005) were independent risk factors for mortality in PD patients.In non-diabetic group,23(6.7%) developed newly-onset fasting plasma hyperglycemia.Lower total urea clearance index(Kt/V)(HR=0.264,95%CI:0.085-0.816,P=0.021) and lower serum potassium levels(HR=0.234,95%CI:0.070-0.779,P=0.018) were independent predictors of newly-onset fasting plasma hyperglycemia.Conclusion As compared with non-diabetics,PD diabetics have a higher mortality rate.However,there is no higher incidence of peritonitis or ultrafiltration failure.The proportion of newly-onset fasting plasma hyperglycemia is 6.7% in non-diabetic PD patients.Lower total Kt/V or lower serum potassium are independent predictors of newly-onset fasting plasma hyperglycemia.