LONG-TERM OUTCOME OF DIABETIC-PATIENTS RECEIVING PERITONEAL-DIALYSIS

Objective: Data from the United States Renal Data Systems (USRDS) sugg est that older diabetic patients with end-stage renal disease will hav e improved survival if they receive hemodialysis versus peritoneal dia lysis. Younger diabetic patients have equal survival on either treatme nt modality. To address more specifically the risk factors for long-te rm survival of diabetic patients receiving peritoneal dialysis, we ana lyzed the long-term outcome of 118 diabetics receiving peritoneal dial ysis over a decade and compared them to 165 nondiabetic patients. Desi gn: Retrospective analysis utilizing the Cox proportional hazards mode l to identify risk factors for survival of both diabetic and nondiabet ic patients.Setting: An experienced, single-center, university-based d ialysis program. Patients: All patients receiving home peritoneal dial ysis for at least one month from 1 January 1981 to 31 December 1990. D iabetics were classified as type I or type II, in addition to age stra tification. Most type I diabetic patients used insulin via the intrape ritoneal route. Main Outcome Measures: Patient survival and technique survival. Results: The most significant risk factor for diabetic patie nt survival was diabetes type (relative risk type I to type II 0.14, p < 0.0001). On treatment serum albumin, predialysis blood urea nitroge n 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 5 5 years was better in nondiabetic patients. Conclusion: These findings of a long-term follow-up period suggest a good survival for younger t ype I diabetic patients receiving peritoneal dialysis. Reasons other t han age for the discrepancy in survival of young versus old diabetics receiving peritoneal dialysis should be sought.