The Long-term Clinical Outcomes Of Peritoneal Dialysis Patients With Type 2 Diabetes And Its Relationship With TCM Syndromes

BackgroundPeritoneal dialysis(PD)has become one of the most important renal replacement therapy modes for patients with end-stage renal disease(ESRD)in China.Type 2 diabetes is the leading cause of ESRD.PD has the advantages of better protecting residual renal function,maintaining hemodynamic stability,free from space and time limitation,and no vascular access.In recent years,more and more patients with type 2 diabetes are receiving PD as their preferred alternative treatment mode.With the improvement of PD technology and medical care level,the long-term survival rate of PD patients with type 2 diabetes has been gradually improved,but the long-term clinical outcomes are worse than that of patients without diabetes.Increasing evidence shows that TCM plays a positive role and has unique advantages in reducing PD complications,improving quality of life,and improving clinical outcomes.In addition,recent studies have shown that different types of TCM syndromes have important effects on the clinical prognosis of PD patients.Therefore,it is of practical significance and clinical guiding value to study the long-term clinical outcomes of PD patients with type 2 diabetes in our center and its relationship with TCM syndromes.ObjectiveThis study aims to evaluate the long-term outcomes of PD patients with and without diabetes,including patient survival,technique survival and peritonitis-free survival,and its relationship with TCM syndromes.In order to further improve the long-term prognosis PD patients with type 2 diabetes and to guide the intervention of traditional Chinese medicine.MethodsWe collected the clinical information of patients with ESRD receiving PD in our center from January 2009 to December 2017 which include baseline demographic information,TCM syndromes,primary disease,comorbidity,laboratory values,and clinical outcomes of the patients,ect.And we screened the eligible people according to the inclusion and exclusion criteria,and divided them into type 2 diabetes group(DM)and non-diabetic group(NDM).Follow-up period was up to December 2019.We first used Kaplan-Meier survival analysis and univariate competitive risk model to compare the differences in cumulative survival,technique survival and peritonitis-free survival between the two groups.Then,multivariate Cox regression and multivariate competitive risk regression models were used to analyze whether type 2 diabetes was an independent risk factor for the above three clinical outcomes in PD patients.Secondly,age,sex and history of CVD were used as interaction terms to further verify the results of the multivariate regression analysis.Finally,Kaplan-Meier survival analysis was used to compare the differences of clinical prognosis between the two groups in different TCM syndromes.ResultsA total of 401 PD patients were enrolled,including 120(29.9%)with type 2 diabetes and 281(70.1%)without diabetes.In terms of TCM syndromes,the top 3 syndromes in this study population were spleen and kidney qi deficiency,damp turbidity and blood stasis;spleen and kidney qi deficiency,damp heat and blood stasis;spleen and kidney qi deficiency,water resistance Shiyu.Among them,the proportion of spleen and kidney qi deficiency,water resistance Shiyu in DM group was the highest(37.5%).The proportion of kidney qi deficiency,damp turbidity and blood stasis in NDM group was the highest(39.1%).The results showed that the patient survival rate in the DM group was lower than that in the NDM group(Log-rank3.215,P<0.0001).The survival rates at 1,2,5,7 and 10 years in the DM group were 98%,91%,64%,43%,11%,respectively,and those in the NDM group were 98%,95%,82%,73%,65%,respectively.In addition,the technique survival rate was lower in the DM group than in the NDM group(Log-rank 2.029,P=0.0180).The technique survival rates at 1,2,5,7 and 10 years in DM group were 91%,87%,76%,71%,53%,respectively.The technique survival rates of non-diabetic patients were 99%,97%,80%,72%,and 70%,respectively.There was no statistically significant difference in peritonitis-free survival between the two groups(Log-rank 1.375,P=0.1133).Multivariate Cox regression and competitive risk regression analysis found that type 2 diabetes was an independent risk factor for increased mortality and technique failure in PD patients.In terms of clinical outcomes of different TCM syndromes between the two groups,the survival of diabetes patients with spleen and kidney qi deficiency,damp turbidity and blood stasis syndromes was lower than that of the NDM group(Log-rank 9.256,P=0.002).There was no statistical difference in the survival rate between the two groups of patients with spleen and kidney qi deficiency,damp heat and blood stasis and spleen and kidney qi deficiency,water resistance Shiyu.There were no statistically significant differences in technique survival and peritonitis-free survival between the two groups with the above three syndromes.ConclusionsPD patients with type 2 diabetes have a higher risk of mortality and technique failure compared with non-diabetes.PD patients with type 2 diabetes with syndrome of spleen and kidney qi deficiency,damp turbidity and blood stasis also have a worse survival.Therefore,closer monitoring and additional focus in patients with DM treated by PD are warranted.