Does Association with Volume Status and Inflammation Account for the Increased Death Risk from High Peritoneal Protein Clearance in Peritoneal Dialysis?

Abstract

Objective: To determine if the association between high peritoneal protein clearance (PrC) and increased all-cause mortality is explained by inflammation and volume overload in continuous ambulatory peritoneal dialysis patients. Subjects and Methods: A total of 216 incident patients were enrolled. Demographics, biochemistry, inflammatory and volume status, peritoneal transport rate, fluid and solute removal were collected at baseline. Results: The median PrC was 57.2 ml/day. A high PrC was associated with more severe inflammation and volume overload. Using a multivariate regression model, for every 1-ml/day increase in PrC, the adjusted HR was 1.06 (1.00–1.12; p = 0.046) for all-cause death adjusted for age, diabetes, hemoglobin and D/Pcr. The predictability of PrC for all-cause death remained the same or mildly changed after additionally adjusted for inflammatory and volume overload markers with HR of 1.07 (1.00–1.14; p = 0.043) and 1.05 (0.99–1.12; p = 0.08), respectively. Conclusions: Peritoneal PrC, although correlated with volume overload and inflammation, is largely an independent predictor of mortality.