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Kidney Week

Abstract: SA-PO638

Peritoneal Dialysis and Technique Survival in Diabetic Patients

Session Information

  • Home Dialysis - II
    November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Paes de Faria, Vitória Vaz da Rocha, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Porto, Portugal
  • Dias, Joana Pereira, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Porto, Portugal
  • Almeida, Catarina, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Porto, Portugal
  • Carmo, Rute, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Porto, Portugal
  • Lopes, Daniela, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Porto, Portugal
  • Fernandes, João Carlos, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Porto, Portugal
  • Almeida, Clara, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Porto, Portugal
  • Gomes, Ana Marta, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Porto, Portugal
Background

Management of end stage renal disease (ESRD) in diabetic patients is an ongoing challenge. Despite potential adverse metabolic effects, peritoneal dialysis (PD) is considered safe and suitable in diabetic ESRD treatment. Previous descriptions of poor technique survival have been contradicted by recent studies, in line with improved dialysis technique and reduced technique-associated complications. We evaluated technique survival in diabetic patients on PD.

Methods

Clinical records of incident PD patients from 2000-2022 were examined. Kaplan-Meier method and log-rank test were used to compare technique survival rate between diabetic and non-diabetic patients. Adjusted HR were calculated using Cox regression.

Results

A total 235 incident PD patients were included, 23% diabetic. Mean age of PD onset 54 ± 15 years. Patients with diabetes mellitus (DM) were older (61 ±14 vs 41 ±15 years), mostly male (74 vs 24%), with higher cardiovascular (CV) burden (p<0.05). Assisted PD modality was more prevalent in this group (29 vs 5%, p<0,05).Median technique survival in DM and non-DM patients was 31 (CI 95% 22-39) and 52 months (CI 95% 42-62), respectively (p=0.002).
Main reasons for PD suspension included technical failure (39%) and PD-associated infectious complications (35%). No significant difference in Infectious complications was observed between the two groups (35% vs. 44%, p= 0.513). Modality suspension due to autonomy loss was higher in DM group (12% vs. 3%, p= 0.05).
In the univariate model, rate of technique failure was higher in the DM group (HR=1.9, CI 95% 1.2-2.8, P = 0.003). This association was not verified in the multivariate model. Due to protocol changes in PD prescription after the availability of biocompatible solutions, separate time period analysis before and after 2008 revealed HR 4.7 (CI 05% 0.75-29.0 P=0.097) and HR of 1.3 (CI 95% 0.3-2.2, p=0.415), respectively.

Conclusion

Decreased technique survival in DM patients was not verified when considering separate time period analysis, with better outcomes in recent years. This reflects technical improvements, biocompatible solutions and prescription tailoring. CV management remains key, and strategies to mitigate the menace of autonomy loss are essential in this subgroup, including helper signaling and increased support for assisted PD.