New-Onset Diabetes Less Likely with Peritoneal Dialysis

ATLANTA—Peritoneal dialysis (PD) patients are half as likely to experience new-onset diabetes mellitus (NODM) as hemodialysis (HD) patients, according to a Chinese study presented at the American Society of Nephrology's Kidney Week 2013 meeting.

Chiu-Ching Huang, MD, and Che-yi Chou, MD, of China Medical University in Taiwan studied propensity-score matched cohorts of 2,548 PD patients and 10,192 HD patients from the Taiwan Renal Registry Database.

The crude NODM incidence rate was 2.2% per year in the PD cohort and 3.7% per year in the HD cohort.  During follow-up, NODM developed in 13% of PD patients and 22% of HD patients. In multivariate analysis, NODM was approximately two times as likely to develop in HD patients as PD patients. Male gender, lower serum albumin, and lower hematocrit were independently linked to increased NODM risks.

The authors speculate that PD patients may be more physically active in their daily life than HD patients, and that increased physical activity may protect against diabetes. In addition, the blood-membrane interaction during HD may induce production of cytokines such as C-reactive protein and interleukin-6. Chronic inflammation induced by blood-membrane interaction may play a critical role in the development of diabetes in HD patients, the researchers noted.

Patients in both groups who developed NODM had increased overall mortality regardless of modality, after adjusting for covariates.

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