The synergistic effect of diabetes mellitus and low high-density lipoprotein cholesterol on the prediction of pneumonia in peritoneal dialysis patients: a multicenter retrospective study

Background: Patients undergoing peritoneal dialysis (PD) often exhibit abnormal glucose and lipid metabolism. Pneumonia is an important infectious complication in PD patients. Diabetes mellitus (DM) and low levels of high-density lipoprotein cholesterol (HDL-C) are risk factors for pneumonia. This study aimed to investigate the relationship between the co-existence of DM and low HDL-C and the occurrence of pneumonia in PD patients. Methods: This multicenter retrospective study was conducted across five PD centers from January 1, 2008, to December 31, 2020. The primary outcome was new-onset pneumonia. Patients were divided into four groups based on the presence of DM and low HDL-C. Cox regression analysis was performed to evaluate the association between the co-existence of DM and low HDL-C and the development of pneumonia. Results: A total of 1,293 PD patients were included in this study. During a median follow-up period of 53 months, pneumonia occurred in 137 patients (10.6%). Multivariable Cox regression analysis demonstrated that patients with coexisting DM and low HDL-C had a significantly increased risk of pneumonia compared to those without either condition (HR = 2.252, 95% CI, 1.232-4.115). Consistent results were observed in subgroup analyses stratified by age, sex, and smoking history. Conclusion: The concurrent assessment of DM and low HDL-C may help identify high-risk individuals for pneumonia and guide the management strategies for PD patients.