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Propensity-matched comparison of mortality between peritoneal dialysis and hemodialysis in patients with type 2 diabetes

  • Nephrology - Original Paper
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Abstract

Background

The optimal choice of dialysis modality for diabetic patients remains controversial. This study aimed to compare mortality between peritoneal dialysis (PD) and hemodialysis (HD) in end-stage renal disease (ESRD) patients with type 2 diabetes (T2D).

Methods

Our observational, longitudinal cohort consisted of all incident ESRD patients with T2D who received either PD or HD in our center from January 2012 to December 2017 and were followed until December 2019. Propensity scores were used to select a 1:1 matched cohort. Mortality was compared between dialysis modalities using Kaplan–Meier survival analysis, and risk factors for mortality were estimated using multivariate Cox regression analyses.

Results

The median follow-up times were 35.5 months in the PD group (n = 134) and 41.6 months in the HD group (n = 134, p = 0.0381). The 1-, 2-, 3-, 5-, and 7-year patient survival rates were 98%, 91%, 77%, 61%, and 35% for diabetic PD patients and 96%, 88%, 81%, 60%, and 57% for diabetic HD patients. Kaplan–Meier survival analysis showed that overall mortality did not significantly differ between modalities (log-rank = 0.9473, p = 0.6575). Using a multivariate Cox regression model, advanced age and increased cholesterol at the initiation of PD treatment were independent risk factors associated with mortality, whereas under HD therapy, the risk factors associated with mortality were lower BMI and higher HbA1c.

Conclusions

These results suggest that in patients with T2D, mortality is comparable between PD and HD irrespective of whether there are the first 2 years or over the 2-year period, and that different mortality predictor patterns exist between patients treated with PD versus HD.

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Funding

This work was financially supported by grants from the Inheritance and Innovation of Traditional Chinese Medicine platform construction for Nephropathy (No. 01030315) and the Project of Administration of Traditional Chinese Medicine of Guangdong Province of China (No. 20192028).

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Author notes

  1. Hui Liu and Zhiren He contribute to this work equally; both are considered to be first authors.

Authors and Affiliations

  1. Department of Nephrology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No.111 Dade Road, Guangzhou, 510120, China

    Hui Liu, Xusheng Liu, Fuhua Lu & Difei Zhang

  2. Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, No.111 Dade Road, Guangzhou, 510120, China

    Hui Liu, Zhiren He, Xiaoxuan Hu, Shaoxue Li, Lixin Wang, Daixin Zhao, Qizhan Lin, Xusheng Liu, Fuhua Lu & Difei Zhang

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  1. Hui Liu
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Correspondence to Fuhua Lu or Difei Zhang.

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This manuscript has been reviewed and approved by all authors, and no results reported in this manuscript have been published elsewhere. All the authors have declared no competing interest.

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Liu, H., He, Z., Hu, X. et al. Propensity-matched comparison of mortality between peritoneal dialysis and hemodialysis in patients with type 2 diabetes. Int Urol Nephrol 54, 1373–1381 (2022). https://doi.org/10.1007/s11255-021-03026-y

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