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

Du Ruo-mei; Zhang Wei; Ji Tian-rong; Kong Fan-wu

doi:10.3969/j.issn.1671-2390.2023.03.001

Journal of Clinical Nephrology > 2023 > 23(3): 177-184. > DOI: 10.3969/j.issn.1671-2390.2023.03.001

Du Ruo-mei, Zhang Wei, Ji Tian-rong, Kong Fan-wu. Effects of diabetes or new-onset hyperglycemia on prognosis in peritoneal dialysis patients[J]. Journal of Clinical Nephrology, 2023, 23(3): 177-184. DOI: 10.3969/j.issn.1671-2390.2023.03.001

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

Department of Nephrology, Second Affiliated Hospital, Harbin Medical University, Harbin 150086, China

Funds:

China Postdoctoral Science Foundation(2017M610213)

Heilongjiang Provincial Postdoctoral Science Foundation(LBH-Z18128)

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Received Date: May 05, 2022
Available Online: May 11, 2023
Published Date: March 27, 2023

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Abstract

Abstract

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.
- Peritoneal dialysis,
- Diabetes mellitus,
- Fasting plasma glucose,
- Prognosis

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References

[1]	Hong YA,Ban TH,Kang CY,et al.Trends in epidemiologic characteristics of end-stage renal disease from 2019 Korean Renal Data System(KORDS)[J].Kidney Res Clin Pract,2021,40(1):52-61.DOI: 10.23876/j.krcp.20.202.
[2]	Lu Y,Stamm C,Nobre D,et al.Changing trends in end-stage renal disease patients with diabetes[J].Swiss Med Wkly,2017,147(2728):w14458.DOI: 10.4414/smw.2017.14458.
[3]	Chen JH,Johnson DW,Wong G,et al.Associations between diabetes and sex with peritoneal dialysis technique and patient survival:results from the Australia and New Zealand Dialysis and Transplant Registry cohort study[J].Perit Dial Int,2021,41(1):57-68.DOI: 10.1177/0896860820918708.
[4]	Lasfar LB,Guedri Y,Zellama D,et al.Long-term clinical outcomes of peritoneal dialysis patients:10-year experience of a single unit from Tunisia[J].Saudi J Kidney Dis Transpl,2019,30(2):451-461.DOI: 10.4103/1319-2442.256852.
[5]	Grzywacz A,Lubas A,Smoszna J,et al.Risk factors associated with all-cause death among dialysis patients with diabetes[J].Med Sci Monit,2021,27:e930152.DOI: 10.12659/MSM.930152.
[6]	Zhang D,Yang Y,Li R,et al.Comparison of long-term outcomes between Chinese peritoneal dialysis patients with and without diabetes:a 10-year cohort study[J].J Diabetes Complicat,2021,35(5):107888.DOI: 10.1016/j.jdiacomp.2021.107888.
[7]	Chang HH,Chang CH,Hsiao CY,et al.Diabetes is the most critical risk factor of adverse complications after peritoneal dialysis catheter placement[J].Front Med(Lausanne),2021,8:719345.DOI: 10.3389/fmed.2021.719345.
[8]	Debray-García Y,Sánchez EI,Rodríguez-Muñoz R,et al.Diabetes and exposure to peritoneal dialysis solutions alter tight junction proteins and glucose transporters of rat peritoneal mesothelial cells[J].Life Sci,2016,161:78-89.DOI: 10.1016/j.lfs.2016.07.018.
[9]	Asari K,Maruyama Y,Kishida K,et al.Comparison of peritoneal function within the first 1 year of peritoneal dialysis between diabetic and non-diabetic patients[J].Ther Apher Dial,2021,25(3):314-322.DOI: 10.1111/1744-9987.13577.
[10]	Huang GS,Wang Y,Shi YF,et al.The prognosis and risk factors of baseline high peritoneal transporters on patients with peritoneal dialysis[J].J Cell Mol Med,2021,25(18):8628-8644.DOI: 10.1111/jcmm.16819.
[11]	Mizumasa T,Hirakata H,Kuroki Y,et al.Diabetes influences peritoneal morphology in uremic patients at the initiation of peritoneal dialysis[J].Perit Dial Int,2013,33(2):175-181.DOI: 10.3747/pdi.2011.00205.
[12]	Lee HB,Ha H.Mechanisms of epithelial-mesenchymal transition of peritoneal mesothelial cells during peritoneal dialysis[J].J Korean Med Sci,2007,22(6):943-945.DOI: 10.3346/jkms.2007.22.6.943.
[13]	Guan JC,Bian W,Zhang XH,et al.Influence of peritoneal transport characteristics on nutritional status and clinical outcome in Chinese diabetic nephropathy patients on peritoneal dialysis[J].Chin Med J(Engl),2015,128(7):859-864.DOI: 10.4103/0366-6999.154275.
[14]	Yarragudi R,Gessl A,Vychytil A.New-onset diabetes mellitus in peritoneal dialysis and hemodialysis patients:frequency,risk factors,and prognosis-a review[J].Ther Apher Dial,2019,23(6):497-506.DOI: 10.1111/1744-9987.12800.
[15]	Roumeliotis S,Dounousi E,Salmas M,et al.Unfavorable effects of peritoneal dialysis solutions on the peritoneal membrane:the role of oxidative stress[J].Biomolecules,2020,10(5):768.DOI: 10.3390/biom10050768.
[16]	Lambie M,Bonomini M,Davies SJ,et al.Insulin resistance in cardiovascular disease,uremia,and peritoneal dialysis[J].Trends Endocrinol Metab,2021,32(9):721-730.DOI: 10.1016/j.tem.2021.06.001.
[17]	郭琴,边帆,蒋更如.腹膜透析后新发糖尿病的相关研究[J].临床肾脏病杂志,2016,16(9):571-574.DOI: 10.3969/j.issn.1671-2390.2016.09.013. Guo Q,Bian F,Jiang GR.Study on new diabetes after peritoneal dialysis[J].J Clin Nephrol,2016,16(9):571-574.DOI: 10.3969/j.issn.1671-2390.2016.09.013.
[18]	Shi YN,Cai JJ,Shi CX,et al.Incidence and mortality of new-onset glucose disorders in peritoneal dialysis patients in China:a meta-analysis[J].BMC Nephrol,2020,21(1):152.DOI: 10.1186/s12882-020-01820-x.
[19]	Park SW,Seo JJ,Bae HS,et al.Difficulty in improving malnutrition and low-grade inflammation in diabetic patients on peritoneal dialysis[J].Ther Apher Dial,2008,12(6):475-483.DOI: 10.1111/j.1744-9987.2008.00638.x.
[20]	Chung SH,Han DC,Noh H,et al.High blood glucose independent of pre-existing diabetic status predicts mortality in patients initiating peritoneal dialysis therapy[J].Int Urol Nephrol,2015,47(6):1017-1024.DOI: 10.1007/s11255-015-0987-z.
[21]	Kishida K,Maruyama Y,Asari K,et al.Clinical outcome of incident peritoneal dialysis patients with diabetic kidney disease[J].Clin Exp Nephrol,2019,23(3):409-414.DOI: 10.1007/s10157-018-1646-3.
[22]	Kim H,Ryu DR.A prime determinant in selecting dialysis modality:peritoneal dialysis patient survival[J].Kidney Res Clin Pract,2017,36(1):22-28.DOI: 10.23876/j.krcp.2017.36.1.22.
[23]	Arora K,Goyal G,Soin D,et al.Correlation of parathyroid hormone levels with mineral status in end-stage renal disease patients[J].Indian J Endocrinol Metab,2018,22(6):735-739.DOI: 10.4103/ijem.IJEM_279_18.
[24]	Cozzolino M,Ciceri P.Serum PTH levels in dialysis:better safe than sorry[J].Ther Adv Endocrinol Metab,2020,11:2042018820974172.DOI: 10.1177/2042018820974172.
[25]	杨超,王晋伟,杨尧政,等.贫血及慢性肾脏病对糖尿病人群心脑血管事件发生与死亡的影响[J].北京大学学报(医学版),2018,50(3):495-500.DOI: 10.3969/j.issn.1671-167X.2018.03.017. Yang C,Wang JW,Yang YZ,et al.Impact of anemia and chronic kidney disease on the risk of cardiovascular disease and all-cause mortality among diabetic patients[J].J Peking Univ Health Sci,2018,50(3):495-500.DOI: 10.3969/j.issn.1671-167X.2018.03.017.
[26]	Dong J,Yang ZK,Chen Y.Older age,higher body mass index and inflammation increase the risk for new-onset diabetes and impaired glucose tolerance in patients on peritoneal dialysis[J].Perit Dial Int,2016,36(3):277-283.DOI: 10.3747/pdi.2015.00182.
[27]	Than WH,Ng JKC,Chan GCK,et al.The change in the prevalence of obesity and new-onset diabetes in Chinese peritoneal dialysis patients over 25 years[J].Clin Kidney J,2021,15(1):70-78.DOI: 10.1093/ckj/sfab139.
[28]	Zhang JL,Yu H,Hou YW,et al.Impact of long-term potassium supplementation on thiazide diuretic-induced abnormalities of glucose and uric acid metabolisms[J].J Hum Hypertens,2018,32(4):301-310.DOI: 10.1038/s41371-018-0036-3.
[29]	Rowe JW,Tobin JD,Rosa RM,et al.Effect of experimental potassium deficiency on glucose and insulin metabolism[J].Metabolism,1980,29(6):498-502.DOI: 10.1016/0026-0495(80)90074-8.
[30]	Gorden P,Sherman BM,Simopoulos AP.Glucose intolerance with hypokalemia:an increased proportion of circulating proinsulin-like component[J].J Clin Endocrinol Metab,1972,34(1):235-240.DOI: 10.1210/jcem-34-1-235.
[31]	Chatterjee R,Slentz C,Davenport CA,et al.Effects of potassium supplements on glucose metabolism in African Americans with prediabetes:a pilot trial[J].Am J Clin Nutr,2017,106(6):1431-1438.DOI: 10.3945/ajcn.117.161570.

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