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Table 3 Mortality of diabetic PD patients

From: Comparison of peritoneal dialysis and hemodialysis as first renal replacement therapy in patients with end-stage renal disease and diabetes: a systematic review

Study/year

PD patients with diabetes

HD patients with diabetes

Confounding factors or factors used for calculating the propensity score

Analysis method

Effect measure

Results

Kim 2017

3996

12,190

Age, sex, NHI, comorbidity (MI, CHF, PAD, cerebrovascular disease, chronic pulmonary disease, peptic ulcer disease, and liver disease), and CCI

Cox proportional hazards model

Hazard ratio

All diabetic patients: 1.27 (1.19–1.35)

Tamayo Isla 2016

13

22

Age, albumin, cholesterol, and hemoglobin

Cox proportional hazards model

Hazard ratio

Diabetic PD patients: 4.99 (2.13–11.71)

Diabetic HD patients: 1.02 (0.43–2.50)

(Reference: non-diabetic HD patients)

Nesrallah 2016

768

768

Age, sex, race, smoking, alcohol, drugs, private coverage, ESRD start date, duration of ESRD, weight, prior transplant, comorbidities (cancer, hypertension, CHF, cerebrovascular disease, peripheral vascular disease, chronic obstructive pulmonary disease, and diabetes), and laboratory values (albumin and hemoglobin)

Cox proportional hazards model (propensity-matched analysis)

Hazard ratio

All diabetic patients: 1.16 (0.99–1.39)

(Reference: diabetic patients with home daily HD)

Lee 2016

265

637

Age, sex, modified CCI, comorbid disease (CAD, PAD, CVA, and CHF), smoker, SBP, DBP, BMI, HbA1c, white blood cells, hemoglobin, BUN, creatinine, albumin, calcium, phosphorous, hs-CRP, ESA, and RRF

Cox proportional hazards model (propensity-matched analysis)

Hazard ratio

All diabetic patients: 0.65 (0.47–0.90)

HbA1c <8.0%: 0.59 (0.37–0.93) (n = 398)

HbA1c ≥8.0%: 1.43 (0.47–2.81) (n = 72)

Marshall 2016

7271

14,309

Age, sex, ethnicity, primary kidney disease, eGFR calculated using MDRD study equation at dialysis therapy initiation, late referral for nephrology predialysis care, diabetes mellitus (none, type 1, and type 2), BMI, medical comorbid conditions (CAD, peripheral vascular disease, cerebrovascular disease, and chronic lung disease), current smoking, and country/state at dialysis therapy initiation

Cox proportional hazards model

Hazard ratio

All diabetic patients: 1.17 (1.11–1.25)

(Reference: diabetic patients with conventional facility HD)

Wang 2016

648

647

Year of stroke diagnosis, year of dialysis initiation, age, sex, and comorbidities (CAD, CHF, cancer, hyperlipidemia, hypertension, diabetes, atrial fibrillation, stroke, chronic hepatitis, and COPD)

Cox proportional hazards model (propensity-matched analysis)

Hazard ratio

All diabetic patients: 1.22 (1.05–1.43)

Waldum-Grevbo 2015

200

209

Age, sex, county, primary cause of ESRD, comorbidities (diabetes mellitus, LVH, established heart disease, PAD, CVD, and previous malignancy), eGFR, hemoglobin, serum albumin, number of antihypertensive drugs, use of statins, ESA, vitamin D supplementation, candidate for future transplantation, and late referral (knowledge of patients < 4 months prior to start of dialysis)

Cox proportional hazards model (propensity-matched analysis)

Hazard ratio

2-year mortality (as-treated): 1.20 (0.76–1.91)

2-year mortality (intention-to-treat): 1.22 (0.80–1.86)

5-year mortality (as-treated): 0.99 (0.69–1.42)

5-year mortality (intention-to-treat): 0.90 (0.65–1.25)

Yang 2015

172

426

Not described

Cox proportional hazards model (propensity-matched analysis)

Hazard ratio

Not described

Kim 2015

3658

11,154

Age, sex, NHI (vs. Medical Aid), diabetes, comorbidities other than diabetes, including any CVD, MI, CHF, PAD, CVA, chronic pulmonary disease, connective tissue disease, peptic ulcer disease, liver disease, and cancer

Multivariate Poisson regression analysis

Adjusted relative risk

All diabetic patients: 1.29 (1.19–1.40)

Marshall 2015

?

?

Age, sex, ethnicity, primary kidney disease, eGFR calculated using MDRD Study equation at dialysis therapy initiation, late referral for nephrology predialysis care, diabetes mellitus (none, type 1, and type 2), BMI, medical comorbid conditions (CAD, peripheral vascular disease, cerebrovascular disease, and chronic lung disease), current smoking, and country/state at dialysis therapy initiation

Cox proportional hazards model

Hazard ratio

Not described

Ryu 2015

?

?

Age, sex, healthcare security system, dialysis modality, and modified CCI

Cox proportional hazards model

Hazard ratio

Age ≥ 65: 1.32 (1.11–1.54)

Age < 65: 1.08 (0.90–1.28)

Marshall 2014

4381

4378

Not described

Cox proportional hazards model

Hazard ratio

All diabetic patients: 1.15 (1.03–1.29)

Follow-up < 3 years: 0.95 (0.83–1.09)

Follow-up > 3 years: 1.54 (1.30–1.82)

Kim 2014

3996

12,190

Age, sex, type of insurance (NHI versus Medical Aid), and the presence or absence of a variety of clinical and coexisting conditions (diabetes mellitus, MI, CHF, CVA, PAD, chronic pulmonary disease, liver disease, peptic ulcer disease, and cancer)

Cox proportional hazards model (propensity-matched analysis)

Hazard ratio

All diabetic patients: 1.27 (1.19–1.35)

Age > 55: 1.35 (1.22–1.48) (n = 4467)

Age ≤ 55: 0.97 (0.82–1.16) (n = 2820)

Heaf 2014

916

1822

First dialysis modality (PD, HD), cohort (according to date of dialysis initiation: 1990–1994, 1995–1999, 2000–2004, 2005–2010), patient age at date of dialysis initiation (categorized into 0-, 60-, 70-, and 80-), sex, renal diagnosis, CCI (categorized into 0, 1–2, ≥ 3), and type of ESRD initiation (early and routine, late and acute, other)

Cox proportional hazards model

Hazard ratio

Diabetes (1990–99): 0.97 (0.84–1.12)

Diabetes (2000–10): 0.86 (0.75–0.97)

Diabetes and ≥ 65 years (1990–1999): 1.00 (0.77–1.29)

Diabetes and ≥ 65 years (2000–2010): 0.85 (0.71–1.01)

Mircescu 2014

194

1246

Age, sex, primary renal disease, and dialysis modality

Cox proportional hazards model

Hazard ratio

Age 18–60 years: 1.73 (1.14–2.62)

Age > 60 years: 0.99 (0.66–1.49)

  1. Abbreviations: HD hemodialysis, PD peritoneal dialysis, NHI National Health Insurance, MI myocardial infarction, CHF congestive heart failure, PAD peripheral artery disease, CCI Charlson comorbidity index, ESRD end-stage renal disease, CAD coronary artery disease, CVA cerebrovascular accident, SBP systolic blood pressure, DBP diastolic blood pressure, BMI body mass index, HbA1c hemoglobin A1c, BUN blood urea nitrogen, hs-CRP high sensitive C-reactive protein, ESA erythropoiesis-stimulating agent, RRF residual renal function, eGFR estimated glomerular filtration rate, MDRD Modification of Diet in Renal Disease, COPD chronic obstructive pulmonary disease, CVD cardiovascular disease