Influence Of Peritoneal Transport Characteristics On Nutritional Status And Clinical Outcome In Diabetic Nephropathy Patients On Peritoneal Dialysis

Background and objecticve:High peritoneal transport status was previously thought to be a poor prognostic factor in peritoneal dialysis (PD) patients. However, it’s effect on diabetic nephropathy PD patients is unclear in consideration of the adverse impact of diabetes itself.The purpose of this study is to analyse the influence of peritoneal transport characteristics on nutritional status and clinical outcome in diabetic nephropathy patients on PD.Methods:102diabetic nephropathy patients on peritoneal dialysis were enrolled in this observational cohort study. According to the initial peritoneal equilibration test (PET) result, patients were divided into2groups:higher transport group (HT, including high and high average transport) and lower transport group (LT, including low and low average transport). Demographic characteristics, biochemical data, dialysis adequacy, and nutritional status were evaluated. Clinical outcomes were compared. Risk factors for death-censored technique failure and mortality were analyzed.Results:The serum albumin was significantly lower [(34.5±3.9vs37.0±3.3)g/L]and the incidence of malnutrition by subjective global assessment (SGA) was significantly higher (44.6%vs24.3%) in HT group (n=65) compared with LT group (n=37)(p<0.05). Kaplan-Meier analyses showed that Death-censored technique survival rates at1,2, and3years were91.8%,71.0%, and50.1%, respectively, in the HT group;97.3%,90.9%and82.4%in the LT group, respectively. Compared with LT group, death-censored technique failure was significantly increased in HT group (log-rankp=0.025). Cumulative proportional patient survival at1,2, and3years were90.2%,77.6%, and61.1%, respectively, in the HT group;94.4%,90.8%and84.3%, respectively, in the LT group. A higher risk of mortality in HT group was observed than in LT group (log-rank p=0.047). On multivariate Cox analyses, higher peritoneal transport status and lower residual renal function (RRF) were independent predictors of death-censored technique failure when adjusted for serum albumin and total weekly urea clearance (Kt/V). Independent predictors of mortality were advanced age, anemia, hypoalbuminemia and lower RRF, but not higher peritoneal transport status.Conclusions:This study suggests that higher peritoneal transport status has an adverse influence on nutrition for diabetic nephropathy patients on PD. Higher peritoneal transport status is a significant independent risk factor for death-censored technique failure, but not for mortality in diabetic nephropathy patients on PD,...