Abstract
BackgroundPeritoneal dialysis (PD) is an easily implementable dialysis modality in end-stage renal disease (ESRD). PD may improve access to renal replacement therapy in low- and middle-income countries; however, these countries have a higher prevalence of protein-energy wasting in patients and poorer socioeconomic conditions. We evaluated the effects of HIV infection on serum albumin levels in ESRD patients starting continuous ambulatory PD (CAPD) and mortality outcomes.MethodsWe conducted a single-center prospective cohort study of consecutive incident CAPD patients recruited from two hospitals in Durban, South Africa, from September 2012 to February 2015. Seventy HIV-negative and 70 HIV-positive ESRD patients were followed monthly for serum albumin levels and mortality events during the first 18 months of CAPD therapy.ResultsThe HIV-positive cohort recorded 28 deaths (40%) among patients with a functional CAPD catheter at 18 months and 13 deaths (18.6%) in the HIV-negative cohort (p = 0.005). The mean serum albumin levels were lower in the HIV-positive cohort than in the HIV-negative cohort during the 18-month follow-up. The mean difference in serum albumin levels between the two cohorts was 4.24 g/L (95% confidence interval [CI] 2.02–6.46, p<0.001) at baseline and 3.99 g/L (95% CI 1.19–6.79, p = 0.006) at 18 months. HIV-positive status (adjusted regression coefficient -2.84, CI -5.00–-0.67, p = 0.011), diabetes (adjusted coefficient -2.85; CI, -5.58–-0.12; p = 0.041), and serum C-reactive protein and blood hemoglobin levels were independent predictors of serum albumin levels on multivariable linear regression. Baseline serum albumin <25 g/L (subdistribution-hazard ratio [SHR] 13.06, 95% CI 3.09–55.14, p<0.001) and CD4+ cell count <200 cells/μL (SHR 3.2, CI 1.38–7.45, p = 0.007) were independent predictors of mortality in our competing risk model.ConclusionsHIV infection can adversely affect serum albumin levels in ESRD patients managed with CAPD, while low baseline serum albumin levels and impaired immunity reliably predict mortality.
Highlights
Peritoneal dialysis (PD) is an implementable renal replacement therapy (RRT) option for patients with end-stage renal disease (ESRD) owing to fewer resource requirements compared to hemodialysis and has been suggested to be a cost-effective approach when favorable country policies underpin its application [1,2,3,4,5]
human immunodeficiency virus (HIV) infection can adversely affect serum albumin levels in ESRD patients managed with continuous ambulatory PD (CAPD), while low baseline serum albumin levels and impaired immunity reliably predict mortality
This study aimed to evaluate the effects of HIV-seropositive status on serum albumin levels in ESRD patients started on continuous ambulatory peritoneal dialysis (CAPD) and the effects of HIV and baseline serum albumin levels on mortality
Summary
Peritoneal dialysis (PD) is an implementable renal replacement therapy (RRT) option for patients with end-stage renal disease (ESRD) owing to fewer resource requirements compared to hemodialysis and has been suggested to be a cost-effective approach when favorable country policies underpin its application [1,2,3,4,5]. Protein-energy wasting (PEW) is an important complication in ESRD, and a number of factors have been recognized to contribute to its development, such as uremia, persistent inflammation, metabolic acidosis, endocrine abnormalities, dialysis-associated losses, and comorbid conditions such as diabetes mellitus and human immunodeficiency virus (HIV) [8,9,10,11,12]. We evaluated the effects of HIV infection on serum albumin levels in ESRD patients starting continuous ambulatory PD (CAPD) and mortality outcomes
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