Published online Oct 15, 2020. doi: 10.4239/wjd.v11.i10.435
Peer-review started: June 27, 2020
First decision: July 30, 2020
Revised: August 9, 2020
Accepted: September 8, 2020
Article in press: September 8, 2020
Published online: October 15, 2020
Processing time: 109 Days and 1.7 Hours
The number of end-stage renal disease patients with diabetes mellitus (DM) who are undergoing peritoneal dialysis is increasing. Peritoneal dialysis-associated peritonitis (PDAP) is a serious complication of peritoneal dialysis leading to technical failure and increasing mortality in patients undergoing peritoneal dialysis. The profile of clinical symptoms, distribution of pathogenic organisms, and response of PDAP to medical management in the subset of end-stage renal disease patients with DM has not been reported previously. Discrepant results have been found in long-term prognostic outcomes of PDAP in patients with DM. It is important to clarify the clinical features and outcomes of PDAP patients with DM.
PDAP in DM patients is very common in the clinical practice, and treatment of PDAP in DM population is difficult and often with poor prognosis. Our research aimed to study the clinical manifestations, distribution of pathogenic organisms, and outcomes of PDAP in DM patients to provide a basis for future research of reasonable treatment and improvement of prognosis in this population.
This study aimed to compare the clinical features and outcomes of PDAP between patients with DM and those without. We found that the distribution of pathogenic organisms of PDAP was different between the DM group and non-DM group, and DM was a significant predictor of all-cause mortality but not technical failure.
This is a multicenter retrospective cohort study. We enrolled patients who had at least one episode of PDAP during the study period. The patients were divided into a DM group and a non-DM group. Clinical features, therapeutic outcomes, and long-term prognostic outcomes were compared between the two groups. Risk factors associated with therapeutic outcomes of PDAP were analyzed using multivariable logistic regression. A Cox proportional hazards model was constructed to examine the influence of DM on patient survival.
We confirmed that the symptoms of PDAP in the DM group were the same as those of the non-DM group (P > 0.05). The DM group had more infections with coagulase-negative Staphylococcus and less infections with Escherichia coli (E. coli) as compared to the non-DM group. DM was not associated with therapeutic outcomes (complete cure, catheter removal, PDAP-related death, or relapse) of PDAP (P > 0.05). The presence of DM was a significant predictor of all-cause mortality (hazard ratio = 1.531, 95% confidence interval: 1.091-2.148, P < 0.05), but did not predict occurrence of technical failure (P > 0.05). However, we did not consider the effect of indicators such as glycosylated hemoglobin and fasting blood-glucose on the outcomes of the study.
The symptoms of PDAP are similar in the DM group and non-DM group. Patients with diabetes are predisposed to coagulase-negative Staphylococcus but not E. coli infection. DM is associated with higher all-cause mortality but not therapeutic outcomes of PDAP.
Future research should focus on the effects of blood glucose control on PDAP outcomes, the mechanism of bacterial colonization, and ways to improve prognosis of PDAP in DM patients.