BACKGROUND The risk of early mortality of patients who start dialysis urgently is high;however,in patients with diabetes undergoing urgent-start peritoneal dialysis(USPD),the risk of,and risk factors for,early mortali...BACKGROUND The risk of early mortality of patients who start dialysis urgently is high;however,in patients with diabetes undergoing urgent-start peritoneal dialysis(USPD),the risk of,and risk factors for,early mortality are unknown.AIM To identify risk factors for mortality during high-risk periods in patients with diabetes undergoing USPD.METHODS This retrospective cohort study enrolled 568 patients with diabetes,aged≥18 years,who underwent USPD at one of five Chinese centers between 2013 and 2019.We divided the follow-up period into two survival phases:The first 6 mo of USPD therapy and the months thereafter.We compared demographic and baseline clinical data of living and deceased patients during each period.Kaplan-Meier survival curves were generated for all-cause mortality according to the New York Heart Association(NYHA)classification.A multivariate Cox proportional hazard regression model was used to identify risk factors for mortality within the first 6 mo and after 6 mo of USPD.RESULTS Forty-one patients died within the first 6 mo,accounting for the highest proportion of mortalities(26.62%)during the entire follow-up period.Cardiovascular disease was the leading cause of mortality within 6 mo(26.83%)and after 6 mo(31.86%).The risk of mortality not only within the first 6 mo but also after the first 6 mo was higher for patients with obvious baseline heart failure symptoms than for those with mild or no heart failure symptoms.Independent risk factors for mortality within the first 6 mo were advanced age hazard ratio(HR:1.908;95%CI:1.400-2.600;P<0.001),lower baseline serum creatinine level(HR:0.727;95%CI:0.614-0.860;P<0.001),higher baseline serum phosphorus level(HR:3.162;95%CI:1.848-5.409;P<0.001),and baseline NYHA class III-IV(HR:2.148;95%CI:1.063-4.340;P=0.033).Independent risk factors for mortality after 6 mo were advanced age(HR:1.246;95%CI:1.033-1.504;P=0.022)and baseline NYHA class III-IV(HR:2.015;95%CI:1.298-3.130;P=0.002).CONCLUSION To reduce the risk of mortality within the first 6 mo of USPD in patients with diabetes,controlling the serum phosphorus level and improving cardiac function are recommended。展开更多
基金Supported by Jilin Province Health and Technology Innovation Development Program Funded Project,No. 2018FP031
文摘BACKGROUND The risk of early mortality of patients who start dialysis urgently is high;however,in patients with diabetes undergoing urgent-start peritoneal dialysis(USPD),the risk of,and risk factors for,early mortality are unknown.AIM To identify risk factors for mortality during high-risk periods in patients with diabetes undergoing USPD.METHODS This retrospective cohort study enrolled 568 patients with diabetes,aged≥18 years,who underwent USPD at one of five Chinese centers between 2013 and 2019.We divided the follow-up period into two survival phases:The first 6 mo of USPD therapy and the months thereafter.We compared demographic and baseline clinical data of living and deceased patients during each period.Kaplan-Meier survival curves were generated for all-cause mortality according to the New York Heart Association(NYHA)classification.A multivariate Cox proportional hazard regression model was used to identify risk factors for mortality within the first 6 mo and after 6 mo of USPD.RESULTS Forty-one patients died within the first 6 mo,accounting for the highest proportion of mortalities(26.62%)during the entire follow-up period.Cardiovascular disease was the leading cause of mortality within 6 mo(26.83%)and after 6 mo(31.86%).The risk of mortality not only within the first 6 mo but also after the first 6 mo was higher for patients with obvious baseline heart failure symptoms than for those with mild or no heart failure symptoms.Independent risk factors for mortality within the first 6 mo were advanced age hazard ratio(HR:1.908;95%CI:1.400-2.600;P<0.001),lower baseline serum creatinine level(HR:0.727;95%CI:0.614-0.860;P<0.001),higher baseline serum phosphorus level(HR:3.162;95%CI:1.848-5.409;P<0.001),and baseline NYHA class III-IV(HR:2.148;95%CI:1.063-4.340;P=0.033).Independent risk factors for mortality after 6 mo were advanced age(HR:1.246;95%CI:1.033-1.504;P=0.022)and baseline NYHA class III-IV(HR:2.015;95%CI:1.298-3.130;P=0.002).CONCLUSION To reduce the risk of mortality within the first 6 mo of USPD in patients with diabetes,controlling the serum phosphorus level and improving cardiac function are recommended。
