Ten years experience of CAPD in diabetics: comparison of results with non-diabetics

CAPD outcomes were compared between a group of 301 diabeticpatients (mean age±SD, 58.9±12.7 years, 55.8%males) and a group of 1689 non-diabetic patients (mean age±SD57.8±14.8 years, 55.9% males) treated in 30 centres participatingin the Italian Cooperative Peritoneal Dialysis Study Group from1980 to 1989, with follow-up observation periods of 444 years(mean±SD, 1.48± 1.24) and of 3502 years (mean±SD,2.07± 1.91) respectively. CAPD was the first modality for 87.2% of diabetics and 78.1%of non-diabetics (P<<0.001). The percentage of patientswho needed a partner for CAPD was 45.9% in diabetics and 30.2%in non-diabetics (P<0.00l). In diabetics compared with non-diabetics, cardiovas cular diseasesand cachexia were nearly twice and infections other than peritonitismore than three times as frequent in causing death. In diabetics,survival was significantly worse (P<0.0001) and the relativerisk of death 2.13 times higher (P<0.001). The technique survival and the relative risk of drop out werenot significantly different in the two groups. Clinical problemswere the most important cause of drop-out among diabetics. Theprobability and relative risk of drop-out due to peritonitis,as well as of the first peritonitis episode, were not significantlydifferent between the two groups and between diabetics usingor not using intraperitoneal insulin. Days per patient year of hospitalization, excluding the first,were 18.4 in diabetics and 14.3 in non diabetics. CAPD-relatedproblems caused hospitalization in a similar way in the twogroups. In conclusion, compared to non-diabetics on CAPD, diabeticson the same treatment showed more clinical problems that accountfor a higher need of partner, death, and hospitalization andare the first reason for technique failure; on the other hand,problems closely related to the CAPD technique seem to occurwith the same frequency in the two groups.