Associations between diabetes and sex with peritoneal dialysis technique and patient survival: Results from the Australia and New Zealand Dialysis and Transplant Registry cohort study

Author:

Chen Jenny HC123ORCID,Johnson David W4567,Wong Germaine8910,Boudville Neil1112,Borlace Monique13,Walker Rachael814,Hawley Carmel4567,McDonald Stephen151617,Lim Wai H1112

Affiliation:

1. School of Medicine, University of New South Wales, Sydney, Australia

2. Department of Renal Medicine, Wollongong Hospital, New South Wales, Australia

3. The George Institute for Global Health, Sydney, New South Wales, Australia

4. Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia

5. Centre for Health Services Research, University of Queensland, Brisbane, Australia

6. Translational Research Institute, Brisbane, Queensland, Australia

7. Australasian Kidney Trials Network, Brisbane, Queensland, Australia

8. Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia

9. Centre for Kidney Research, The Children’s Hospital at Westmead, New South Wales, Australia

10. Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia

11. Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

12. Medical School, University of Western Australia, Perth, Australia

13. Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, South Australia, Australia

14. Eastern Institute of Technology, Napier, New Zealand

15. Central and Northern Adelaide Renal and Transplantation Services, South Australia, Australia

16. Adelaide Medical School, The University of Adelaide, South Australia, Australia

17. Australia and New Zealand Dialysis and Transplant Registry, SA Health and Medical Research Institute, Adelaide, South Australia, Australia

Abstract

Background: A differential association between mortality and cause of end-stage kidney disease in patients with type 2 diabetes mellitus (T2DM) has been shown. Sex-specific differences in diabetes-related complications have been described. It is unclear whether sex affects the associations between diabetes and peritoneal dialysis (PD) technique and patient survival. Methods: Using the Australia and New Zealand Dialysis and Transplant Registry, we examined a two-way interaction between sex and diabetes status (no diabetes, T2DM and non-diabetic nephropathy [T2DM + non-DN] and T2DM and diabetic nephropathy [T2DM + DN]) for PD technique failure (including death), all-cause mortality and cause-specific mortality in incident adult PD patients between 1996 and 2016 using adjusted Cox regression. Mediation analysis was conducted to determine whether peritonitis was a mediator in these associations. Results: In 8279 PD patients, those with T2DM + DN had the greatest risks in technique failure, all-cause mortality and cause-specific mortality followed by patients with T2DM + non-DN, then patients without diabetes. Sex modified the association with diabetes status in technique failure ( p interaction = 0.001) and cardiac mortality ( p interaction = 0.008). In women with T2DM + DN, the adjusted hazard ratio (HR) for technique failure was 1.45 (1.30–1.62) and was higher than men with T2DM + DN (1.17 [1.08–1.28]; referent: no diabetes). In women with T2DM + DN, the adjusted HR for cardiac mortality was 2.12 (1.73–2.61) and was also higher than men with T2DM + DN (1.66 [1.43–1.95]). Less than 10 % of the effect between diabetes and PD technique failure or mortality was mediated by peritonitis. Conclusions: PD patients with diabetic nephropathy had increased risk of PD technique failure and mortality, with the magnitude of these risks greater in women.

Publisher

SAGE Publications

Subject

Nephrology,General Medicine

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