Abstract
This study investigated the clinical outcomes and mortality risks in elderly peritoneal dialysis (PD) patients with diabetes mellitus (DM). A total of 210 incident PD patients aged 70 years or older (mean age 80.7 ± 5.0 years; 60.5% men) who initiated treatment between 2009 and 2020 were analyzed, including 81 (38.6%) with DM. Compared with non-diabetic patients, those with DM were younger (79.6 ± 4.7 vs. 81.4 ± 5.0 years, p = 0.011), and had higher fasting glucose (6.18 [4.53-9.30] vs. 4.88 [4.40-5.63] mmol/L, p < 0.001) and HbA1c (6.10% [5.43-6.78] vs. 5.40% [5.00-5.70], p < 0.001). Annualized mortality was 0.22 deaths per patient-year (95% CI 0.16-0.29) in the DM group and 0.20 (95% CI 0.16-0.25) in the non-DM group. Kaplan-Meier survival analysis revealed no significant differences in patient survival (p = 0.479), peritonitis-free survival (p = 0.953), or technique survival (p = 0.763) between the two groups in this cohort. In both Cox and Fine-Gray models, female sex (HR 1.505, 95% CI 1.033-2.193; p = 0.033) was an independent risk factor for all-cause mortality, whereas higher serum albumin (per 1 g/L increase: HR 0.938, 95% CI 0.906-0.971; p < 0.001) and higher residual kidney function (per 1 mL/min/1.73 m² increase: HR 0.881, 95% CI 0.808-0.960; p = 0.004) were independent protective factors. DM did not significantly predict mortality (HR 1.260, 95% CI 0.830-1.913; p = 0.279). These findings suggest that DM is not associated with worse clinical outcomes in elderly PD patients and may not represent a barrier to PD initiation.