Long-term outcome of diabetic patients receiving peritoneal dialysis

Objective: Data from the United States Renal Data Systems (USRDS) suggest that older diabetic patients with end-stage renal disease will have improved survival if they receive hemodialysis versus peritoneal dialysis. Younger diabetic patients have equal survival on either treatment modality. To address more specifically the risk factors for long-term survival of diabetic patients receiving peritoneal dialysis, we analyzed the long-term outcome of 118 diabetics receiving peritoneal dialysis over a decade and compared them to 165 nondiabetic patients. Design: Retrospective analysis utilizing the Cox proportional hazards model to identify risk factors for survival of both diabetic and nondiabetic patients. Setting: An experienced, single-center, university-based dialysis program. Patients: All patients receiving home peritoneal dialysis for at least one month from 1 January 1981 to 31 December 1990. Diabetics were classified as type I or type II, in addition to age stratification. Most type I diabetic patients used insulin via the intraperitoneal route. Main Outcome Measures: Patient survival and technique survival. Results: The most significant risk factor for diabetic patient survival was diabetes type (relative risk type I to type II 0.14, p < 0.0001). On treatment serum albumin, predialysis blood urea nitrogen and predialysis serum cholesterol were also significant risk factors (p < 0.01). For nondiabetic patients, age, on treatment serum albumin, and current smoking were significant survival risk factors. Survival of patients 55 years or less was not significantly different between diabetic and nondiabetic patients. Survival of patients greater than 55 years was better in nondiabetic patients. Conclusion: These findings of a long-term follow-up period suggest a good survival for younger type I diabetic patients receiving peritoneal dialysis. Reasons other than age for the discrepancy in survival of young versus old diabetics receiving peritoneal dialysis should be sought.