Associations between diabetes status, sex and peritoneal dialysis clinical outcomes – an Australia and New Zealand Dialysis and Transplant registry cohort study

Dr Jenny HC Chen1,2, Prof David Johnson3,4,5,6, A/Prof Germaine Wong7,8,9, Prof Neil Boudville10,11, Ms Monique Borlace12, A/Prof Rachael Walker7,13, Prof Carmel Hawley3,4,5,6, Prof Stephen McDonald14,15,16, A/Prof Wai Lim10,11

1Wollongong Hospital, Wollongong, Australia, 2University of New South Wales, Sydney, Australia, 3Princess Alexandra Hospital, Brisbane, Australia, 4University of Queensland, Brisbane, Australia, 5Translational Research Institute, Brisbane, Australia, 6Australasian Kidney Trials Network, Brisbane, Australia, 7University of Sydney, Sydney, Australia, 8Centre for Kidney Research, Sydney, Australia, 9Westmead Hospital, Sydney, Australia, 10Sir Charles Gairdner Hospital, Perth, Australia, 11University of Western Australia, Perth, Australia, 12Royal Adelaide Hospital, Adelaide, Australia, 13Eastern Institute of Technology, Napier, New Zealand, 14Central and Northern Adelaide Renal and Transplantation Services, Adelaide, Australia, 15The University of Adelaide, Adelaide, Australia, 16Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia

Introduction

Sex-specific differences in diabetes-related complications have been described. It is unclear whether sex is an effect modifier between diabetes status, peritoneal dialysis (PD) outcomes and mortality.

Methods

Using data from the Australia and New Zealand Dialysis and Transplant registry, we examined for a two-way interaction between sex and diabetes status (categorised as 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 and cause-specific mortality in incident adult PD patients between 1996-2016 using adjusted Cox regression analyses.

Results

Of 8279 PD patients, 5383 (65%) patients experienced PD technique failure and 2660 (32%) died, with 1496 (36%) attributed to cardiac mortality. Sex modified the association between diabetes status and PD technique failure (Pinteraction=0.001) and cardiac mortality (Pinteraction=0.008), but not with all-cause mortality. The adjusted hazard ratios (HRs) for technique failure were 1.13 (95%CI 1.03-1.24) for T2DM+non-DN and 1.28 (1.20-1.37) for T2DM+DN (reference: no diabetes). In women with T2DM, the adjusted HR was 1.45 (1.30-1.62) and was higher than men with T2DM+DN (1.17 [1.08-1.28]; referent: no diabetes). For cardiac mortality, the adjusted HRs were 1.44 (1.21-1.70) for T2DM+non-DN and 1.82 (1.61-2.06) for T2DM+DN. In women with T2DM+DN, the adjusted HR was 2.12 (1.73-2.61) and was also higher than men with T2DM+DN (1.67 [1.43-1.95]).

Conclusion

PD patients with diabetes had increased risk of PD technique failure and mortality, with the magnitude of these risks greater for those whose cause of ESKD was attributed to diabetic nephropathy and in women.


Biography:

Jenny is a nephrologist currently working at Wollongong Hospital, NSW. She completed her nephrology training in Sydney and went to Vancouver, Canada, for a year of home dialysis fellowship in 2018. She studied Master of Clinical Epidemiology through the University of Sydney. Jenny has a strong interest in home dialysis, especially peritoneal dialysis, as well as renal supportive care.

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