Impact of diabetes on survival and clinical outcomes in elderly patients receiving peritoneal dialysis

Abstract

This study investigated the clinical outcomes and mortality risks in elderly peritoneal dialysis (PD) patients with diabetes mellitus (DM). A total of 210 incident PD patients aged 70 years or older (mean age 80.7 ± 5.0 years; 60.5% men) who initiated treatment between 2009 and 2020 were analyzed, including 81 (38.6%) with DM. Compared with non-diabetic patients, those with DM were younger (79.6 ± 4.7 vs. 81.4 ± 5.0 years, p = 0.011), and had higher fasting glucose (6.18 [4.53–9.30] vs. 4.88 [4.40–5.63] mmol/L, p < 0.001) and HbA1c (6.10% [5.43–6.78] vs. 5.40% [5.00–5.70], p < 0.001). Annualized mortality was 0.22 deaths per patient-year (95% CI 0.16–0.29) in the DM group and 0.20 (95% CI 0.16–0.25) in the non-DM group. Kaplan-Meier survival analysis revealed no significant differences in patient survival (p = 0.479), peritonitis-free survival (p = 0.953), or technique survival (p = 0.763) between the two groups in this cohort. In both Cox and Fine–Gray models, female sex (HR 1.505, 95% CI 1.033–2.193; p = 0.033) was an independent risk factor for all-cause mortality, whereas higher serum albumin (per 1 g/L increase: HR 0.938, 95% CI 0.906–0.971; p < 0.001) and higher residual kidney function (per 1 mL/min/1.73 m² increase: HR 0.881, 95% CI 0.808–0.960; p = 0.004) were independent protective factors. DM did not significantly predict mortality (HR 1.260, 95% CI 0.830–1.913; p = 0.279). These findings suggest that DM is not associated with worse clinical outcomes in elderly PD patients and may not represent a barrier to PD initiation.