Abstract: Objective  To explore the predictive value of total bilirubin to albumin ratio (TBAR) on cardiovascular disease morality in peritoneal dialysis (PD) patients with diabetes mellitus.  Methods  This study was a single center and retrospective study aiming to analyze the clinical data of diabetes mellitus patients undergoing PD catheterization in the Northern Theater Command General Hospital from January 2013 to September 2021. The restricted cubic spline (RCS) was used to determine the cutoff value of TBAR. Patients were divided into low TBAR and high TBAR groups according to the cutoff value of TBAR. Kaplan-Meier method was used to compare the overall survival rate, and multivariate Cox regression proportional hazards model was used to analyze the risk factors affecting the cardiovascular disease mortality.  Results  A total of 203 PD patients with diabetes mellitus were included in this study. RCS showed that the cutoff value of TBAR predicting cardiovascular disease morality was 0.142. The study subjects were then divided into low TBAR group (n=103) and high TBAR group (n=100). The high TBAR group had higher calcium (Z=-1.996, P=0.046) and total bilirubin (Z=-11.202, P＜0.001), and lower serum creatinine (Z=-2.015, P=0.044), phosphorus (Z=-3.525, P＜0.001) and platelet (t=2.924, P=0.004) as compared with those in the low TBAR group. Kaplan-Meier analysis showed that the survival rate was 12.60% in the high TBAR group and was 75.20% in the low TBAR group (Log rank, χ2=8.616, P=0.003). After adjusting for confounding factors, multivariate cox regression analysis showed that TBAR (HR=2.131, 95% CI：1.102～4.121, P=0.025), body mass index (HR=0.859, 95% CI：0.781～0.944, P=0.002), and serum creatinine (HR=0.998, 95% CI：0.7996～1.000, P=0.017) were the risk factors for cardiovascular disease morality in PD patients with diabetes mellitus.  Conclusion TBAR can be used as a simple indicator to evaluate prognosis of the patients. TBAR higher than 0.142 is an independent risk factor for cardiovascular disease morality in PD patients with diabetes mellitus.

Key words:  Peritoneal dialysis, Diabetes mellitus, Total bilirubin, Albumin