Patients with diabetes who have a small kidney size at the start of peritoneal dialysis (PD) have a significantly higher risk of death than those with enlarged or normal sized kidneys, according to a new study.
The multivariate statistical analysis found that patients with small kidneys were more than six times more likely to be mortality (odds ratio 6.452; 95% CI 1.220-34.482, P = 0.028), according to a study in Scientific Reports.
Half of the patients with small kidney sizes died (n = 8) versus 9.0% (n = 6; P <0.001) of the patients with normal or enlarged kidney sizes. In addition, there was higher infection-related mortality in patients with small kidneys than in patients with normal or enlarged kidneys (43.8% versus 7.5%; P <0.001), with 7 of the 8 deaths in patients with small kidneys due to infection occurred.
The study was conducted by researchers in Taiwan, where the incidence and prevalence of end-stage kidney disease (ESKD) are highest in the world. In 2016, Taiwan’s incidence was 493 patients per million, well ahead of the US at 378 per million.
Most patients with ESKD with high blood urea levels in Taiwan are treated on hemodialysis. This study included those who were treated with PD. There has been a trend in Taiwan to shift from inpatient care for elderly patients to home care where Parkinson’s disease can occur, the authors found. Most families in Taiwan are large families, according to the authors, so there tends to be younger family members to care for older parents who develop Parkinson’s disease.
The study included 83 patients with diabetes who received PD in the hospital between 2015 and 2019. Most had normal or enlarged kidney sizes at the start of PD (n = 67; 80.7%); The remainder had a small kidney size (n = 16; 19.3%).
The study also identified several common features in patients with small kidney sizes, a rare condition found in those with diabetes. Patients had a mean (SD) elderly age of 76.63 (10.63) versus 68.03 (11.26) years (P = 0.007); had a longer median diabetes duration of 272.09 (305.09) versus 151.44 (85.31) months (P = 0.006); and were predominantly female (75.0% versus 41.8%; P = 0.017).
In addition, they had lower serum creatinine levels at 9.63 (2.82) versus 11.74 (3.32) mg / dL (P = 0.022) and albumin at 3.23 (0.67) versus 3.60 (0 .47) g / dl (P =). 010).
Patients with diabetes are prone to developing infections, the authors noted, as the hyperglycemic environment supports immune dysfunction such as impaired neutrophil function, suppression of the antioxidant system, and humoral immunity. In addition, the presence of enlarged kidneys is far more common in those with diabetes than in those with small kidneys. A recent study found that the presence of diabetes was linked to a 1.723 times the risk of having a large kidney. Enlarged kidneys predict poor outcomes in people with diabetes and chronic kidney disease.
The authors said older age, longer duration of diabetes, and malnutrition (lower blood creatinine and albumin levels) could correlate with increased mortality.
They concluded that this is the first study to compare results between patients with diabetes with enlarged or normal kidneys and those with small kidneys.
reference
Chen CH, Chen CY, Yu MC et al. Influence of kidney size on mortality in diabetics receiving peritoneal dialysis. Sci Rep. 2021; 11 (1): 8203. doi: 10.1038 / s41598-021-87684-z
