Technique Failure in Peritoneal Dialysis: A Comparative Study of Diabetic and Non-Diabetic Patients in Northern Hunan Province, China

Abstract Objective To compare the risk of technique failure and clinical outcomes between diabetic and non-diabetic peritoneal dialysis (PD) patients in northern Hunan province, China, and to identify independent predictors for individualized intervention. Methods This retrospective study enrolled 550 patients (aged ≥ 18 years, dialysis > 3 months) who initiated PD at Yiyang Central Hospital from January 2009 to December 2024. Patients were divided into diabetes mellitus (DM) (n = 205) and non-diabetes mellitus (NDM) (n = 345) groups. The primary endpoint was technique failure (transfer to hemodialysis or death). Cox regression was used to identify risk factors, and Kaplan-Meier analysis with log-rank tests compared survival rates, with subgroup analyses performed. Results At the end of follow-up, among the 155 patients remaining on PD, 44 (22.9%) had DM, and 111 (32.2%) did not have DM ( p = 0.007). Among the 265 deceased patients, 111 (54.2%) had DM, and 154 (44.6%) did not have DM ( p = 0.033). Cardiovascular disease was the main cause of death in both DM and NDM patients. There was a statistically significant difference in the cause of death between the two groups in terms of infection ( p < 0.041). Multivariate Cox regression analysis revealed that age (HR = 1.022), systolic blood pressure (HR = 1.006), serum albumin (HR = 0.975), history of diabetic kidney disease (HR = 1.511), and comorbid chronic obstructive pulmonary disease (COPD) (HR = 2.447) were all independent predictors of technique failure (all P < 0.05). Subgroup analyses showed that low albumin (< 25.0 g/L, < 35.0 g/L,), older age (≥ 58 years, ≥ 70 years), high systolic blood pressure (≥ 148 mmHg), and COPD significantly increased technique failure risk in NDM patients, whereas these associations were not statistically significant within the DM subgroup for albumin, age, or blood pressure. Conclusion Diabetes mellitus substantially elevates the risk of PD technique failure. Independent risk factors encompass older age, higher systolic blood pressure, low serum albumin levels, a history of diabetic kidney disease, and comorbid COPD. Therefore, interventions targeting patients with these risk factors are important for improving long-term outcomes.