Lower Charlson Comorbidity Index Research Articles

Completeness of prostate cancer staging in the Danish Cancer Registry, 2004–2009

ObjectiveTo investigate the completeness of TNM (Tumor-Node-Metastasis) staging for prostate cancer (PC) in the Danish Cancer Registry (DCR).MethodsWe identified 20,184 men registered with first-time PC in the DCR between 2004 and 2009. These patients were linked to the Danish National Patient Register to obtain data on comorbidity according to the Charlson Comorbidity Index (CCI). We calculated the completeness and corresponding 95% confidence intervals (CI) of TNM staging overall and by the individual components. We also defined a clinically-based algorithm classifying PC into four stage categories: localized, regional, distant, and unknown.ResultsThe overall completeness of TNM staging was 34.2% (95% CI: 0.34–0.35). TNM completeness improved gradually over time reaching 41.2% in 2009. TNM completeness decreased substantially with age from 75.0% among patients 0–39 years to 11.3% among patients 80 years or older. Similarly, completeness decreased with increasing comorbidity level from 37.6% among patients with low CCI to 20.3% among those with high CCI. When classifying T1 cancer as a complete registration regardless of missing N or M stage, the overall TNM completeness increased to 48.7% (95% CI: 0.48–0.49). According to the clinically-based staging algorithm, 70.5% of PC cases could be categorized into a definite clinical stage.ConclusionOne-third of PC patients had a complete registration of all TNM components in the DCR. Although TNM completeness improved over time, older age and high comorbidity were consistently associated with missing TNM staging. Research and monitoring based on cancer registries such as the DCR should account for missing TNM staging. Failing to do so could otherwise lead to biased results of stage-specific analyses.

Do physician communication skills influence screening mammography utilization?

BackgroundThe quality of physician communication skills influences health-related decisions, including use of cancer screening tests. We assessed whether patient-physician communication examination scores in a national, standardized clinical skills examination predicted future use of screening mammography (SM).MethodsCohort study of 413 physicians taking the Medical Council of Canada clinical skills examination between 1993 and 1996, with follow up until 2006. Administrative claims for SM performed within 12 months of a comprehensive health maintenance visit for women 50–69 years old were reviewed. Multivariable regression was used to estimate the relationship between physician communication skills exam score and patients’ SM use while controlling for other factors.ResultsOverall, 33.8 % of 96,708 eligible women who visited study physicians between 1993 and 2006 had an SM in the 12 months following an index visit. Patient-related factors associated with increased SM use included higher income, non-urban residence, low Charlson co-morbidity index, prior benign breast biopsy and an interval >12 months since the previous mammogram. Physician-related factors associated with increased use of SM included female sex, surgical specialty, and higher communication skills score. After adjusting for physician and patient-related factors, the odds of SM increased by 24 % for 2SD increase in communication score (OR: 1.24, 95 % CI: 1.11 - 1.38). This impact was even greater in urban areas (OR 1.30, 95 % CI: 1.16, 1.46) and did not vary with practice experience (interaction p-value 0.74).ConclusionPhysicians with better communication skills documented by a standardized licensing examination were more successful at obtaining SM for their patients.

Impact of Thrombolysis on Stroke Outcome at 12 Months in a Population: Fischer U, Mono ML, Zwahlen M, et al. Stroke 2012;43:1039–45.

Multiple clinical trials have shown that thrombolytics improve short-term outcomes in individuals with acute ischemic stroke (AIS). Several similar studies show that thrombolytics also improve long-term outcomes. What is not clear, and what this article attempted to address, is whether these findings can be replicated in a single study population. Investigators prospectively assessed 807 patients with first-time AIS who were admitted to the hospital within 48 h of symptom onset in Bern, Switzerland over the course of 12 months. Of the 807 total patients, 13% (n = 107) received thrombolysis. Thirty-eight percent of patients (n = 41) received intra-arterial thrombolysis, 33% (n = 35) received intravenous thrombolysis, and 5% (n = 5) underwent mechanical thrombolysis. Median National Institute of Health Stroke Scale (NIHSS) at admission was 14 in the group that received thrombolytics (n = 107) and 4.3 in the group that did not receive thrombolytics (n = 700). Follow-up was then obtained at 3 and 12 months to assess for predictors of mortality as well as favorable outcomes. Favorable outcomes were defined as a modified Rankin Scale ≤ 2. The authors found that the following variables were independent predictors of mortality at 3 months and 12 months: age ≥ 75 years, higher NIHSS, and higher Charlson comorbidity index. They found that the following variables were independent predictors of favorable outcomes at 3 and 12 months: age < 75 years, male gender, NIHSS < 4, lower Charlson comorbidity index, and thrombolysis. The authors emphasize that thrombolysis is the only modifiable variable that was shown to predict favorable outcomes at 3 months (relative risk [RR] 1.49; 95% confidence interval [CI] 1.18–1.89) and 12 months (RR 1.59; 95% CI 1.24–2.04).

Noncancer Palliative Care

Little is known about the picture of patients receiving palliative care in the acute care setting. The study was conducted in a medical center in Taiwan. Cancer palliative care (CPC) was performed for terminal do-not-resuscitate (DNR) patients with advanced cancers. Noncancer palliative care (NCPC) was performed for DNR patients who did not fulfill the criteria of CPC. Of the 1379 consecutive admissions, 258 patients were identified, with 193 (74.8%) requiring NCPC and 65 (25.2%) requiring CPC. The NCPC patients were older and had lower Charlson comorbidity index (2.6 vs 8.6, P &lt; .001) than CPC patients and had poorer consciousness and more organ failure than CPC patients when recognized. Many noncancer patients without access to specialist palliative care services were treated in the acute care setting with delayed recognition.

PMS40 Medication Adherence among Patients with Rheumatoid Arthritis

The main objective of this study was to assess the medication adherence among individuals with rheumatoid arthritis (RA) enrolled in a state Medicaid fee-for-service (FFS) program. Factors influencing medication adherence were identified. Lastly, the role of adherence in influencing the utilization of acute care services (hospitalization/emergency room visit) was ascertained. The target population included nonelderly adult recipients (21-64 years) who were continuously enrolled in the Mississippi Medicaid FFS program from January 1, 2006 to December 31, 2007. Recipients who had a medical services claim with a primary or secondary diagnosis of RA in calendar year 2006 were identified. Medication adherence (measured as proportion of days covered (PDC)) was determined using calendar year 2007 data. Recipients with adherence (PDC) ≥80% were classified as adherent. Logistic regression analyses were used to determine factors predicting medication adherence and the effect of adherence on acute care services utilization. Roughly 20% of recipients with RA were adherent. Older age (odds ratio (OR) = 1.031; p<0.005), white race (OR= 1.684; p<0.005), and lower Charlson comorbidity index (CCI) score (OR= 0.785; p<0.005) were significant predictors of adherence. Adherence did not have a significant association with acute care services utilization after controlling for demographic and disease-related covariates. Only one in five Medicaid recipients with RA were found to be adherent. Lower levels of adherence among individuals with RA could contribute to poor outcomes in these individuals over time. Policy makers should undertake intervention programs aimed at increasing medication adherence in this underprivileged population.

The impact of age, Charlson comorbidity index, and performance status on treatment of elderly patients with diffuse large B cell lymphoma

Treatment intensity will affect outcome in elderly patients with diffuse large B cell lymphoma (DLBCL). We retrospectively reviewed 333 DLBCL patients aged over 60 years who were diagnosed between January 2003 and December 2010 to evaluate the difference between different treatment regimens. The median age was 73 years; 56.8 % of patients received treatment with rituximab-containing regimens. In univariate analysis, patients with younger age, better performance status, early Ann Arbor stage, lower International Prognostic Index (IPI), normal serum lactate dehydrogenase, normal serum albumin, or normal serum beta-2 microglobulin received more intensive treatment regimens. In multivariate analysis, patients with younger age (p < 0.001) or better performance status (p = 0.027) received treatment of more intensive regimens. The treatment regimens were not different between patients with lower and higher Charlson comorbidity index (CCI). Female gender, normal serum beta-2 microglobulin, lower CCI, lower IPI, and treatment with more intensive regimens predicted better progression-free survival and overall survival in multivariate analysis. Patients treated with rituximab-containing regimens had better progression-free survival (median 22.2 vs. 9.9 months, p = 0.005) and better overall survival (median 34.9 vs. 21.8 months, p = 0.042) as compared to those treated without rituximab. In conclusion, our results showed that patients with younger age or better performance status received more intensive treatment. The treatment regimen was not different between patients with lower and higher CCI. Rituximab-containing regimens improved the outcome of elderly patients with DLBCL.

Impact of Thrombolysis on Stroke Outcome at 12 Months in a Population

Thrombolysis improves outcome of patients with acute ischemic stroke, but it is unknown whether thrombolysis has a measurable effect on long-term outcome in a defined population. We prospectively assessed demographic data, management, and outcome of acute ischemic stroke patients admitted within 48 hours to 18 primary care hospitals of the canton of Bern (969 299 inhabitants) during 12 months. Blinded follow-up was obtained at 3 and 12 months. Predictors of mortality and favorable outcome (modified Rankin Scale score ≤2) at 3 and 12 months using logistic regression were analyzed. From December 2007 to December 2008, 807 patients (mean age, 72 years) were included. Median National Institutes of Health Stroke Scale score on admission was 5; 107 patients (13%) received intravenous, intra-arterial, or mechanical thrombolysis. Estimated cumulative mortality at 3 months was 20.6% and at 12 months 27.4%. Age 75 years or older, higher National Institutes of Health Stroke Scale scores, and higher Charlson comorbidity index were independent predictors of mortality at 3 and 12 months. Estimated favorable outcome at 3 months was 48.2% and at 12 months was 44.6%. Thrombolysis was the only modifiable independent predictor of favorable outcome at 3 (relative risk, 1.49; 95% CI, 1.18-1.89) and 12 months (relative risk, 1.59; 95% CI, 1.24-2.04), whereas age younger than 75 years, male gender, National Institutes of Health Stroke Scale score <4, and lower Charlson comorbidity index were nonmodifiable predictors. Thirteen percent of acute ischemic stroke patients admitted within 48 hours to Bernese hospitals underwent thrombolysis, which exerted a measurable effect on 3-month outcome in this population. This effect was sustained at 12 months. Age, stroke severity, Charlson comorbidity index, and male gender were independent nonmodifiable predictors of outcome.

Radical Prostatectomy at Academic Versus Nonacademic Institutions: A Population Based Analysis

Radical prostatectomy outcomes may be better at academic institutions than at nonacademic centers. We examined the effect of academic status on 5 short-term radical prostatectomy outcomes. In the Health Care Utilization Project Nationwide Inpatient Sample we focused on radical prostatectomy performed within the 7 most contemporary years (2001 to 2007). We tested the rates of homologous blood transfusions and extended length of stay, as well as intraoperative and postoperative complications stratified according to institutional academic status. Multivariable logistic regression analyses further adjusted for confounding variables. Overall 89,965 radical prostatectomies were identified, yielding a weighted national estimate of 442,811. Of those procedures 58.2% were recorded at academic institutions. Patients at academic institutions had a lower Charlson comorbidity index and more frequently had private insurance (p <0.001). Radical prostatectomy at academic institutions was associated with fewer blood transfusions (5.4% vs 7.4%), fewer postoperative complications (10.1% vs 12.9%) and lower rates of hospital stay above the median (18.0% vs 28.2%). On multivariable analyses institutional academic status exerted a protective effect on postoperative complication rates (OR 0.93, p = 0.02) and on rates of hospital stay in excess of the median (OR 0.91, p <0.001). Similarly radical prostatectomy performed at hospitals with a high annual caseload were less frequently associated with intraoperative (OR 0.8, p = 0.01) and postoperative (OR 0.63, p <0.001) complications, length of stay beyond the median (OR 0.19, p <0.001) and homologous blood transfusions (OR 0.35, p <0.001). Even after adjusting for annual hospital caseload, radical prostatectomy performed at academic institutions is associated with better outcomes than radical prostatectomy performed at nonacademic institutions. This relationship illustrates averages and does not imply that academic institutions invariably offer better care.

Does partial nephrectomy at an academic institution result in better outcomes?

Partial nephrectomy (PN) outcomes may be better at academic institutions than at non-academic centers. Peer-review, sub-specialized practice profile, higher individual surgeon and institutional caseload may explain this observation. To the best of our knowledge, the role of institutional academic affiliation has not been examined with regard to PN postoperative outcomes. Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS), we focused on PNs performed within the 10 most contemporary years (1998-2007). We explored the effect of academic status on three short-term PN outcomes (intraoperative and postoperative complications, as well as in-hospital mortality). Multivariable logistic regression analyses further adjusted for age, race, gender, Charlson Comorbidity Index (CCI), surgical approach, hospital region, annual hospital caseload and insurance status. Overall, 8,513 PNs were identified. Of those, 5,906 (69.4%) were recorded at academic institutions. Academic institution patients had lower CCI, were less frequently Caucasian and more frequently had private insurance (all P<0.001). Academic institution PNs were associated with fewer postoperative complications (14.6% vs. 16.6%, P=0.018). In multivariable analyses, institutional academic status did not affect the three short-term PN outcomes. Patient selection explains better PN postoperative outcomes at academic institutions. Control for these biases removes the outcome differences, at least when the three short-term PN outcomes are considered. However, the interpretation of these findings needs to take into account the lack of adjustment for case complexity.

Patient Factors Associated with Glucagonlike Peptide 1 Receptor Agonist use with and without Insulin

To evaluate both the patient factors associated with the initiation of exenatide and the real-world treatment patterns of exenatide use with and without insulin. Using retrospective electronic medical records from the General Electric Centricity database, we performed analyses of 2 cohorts to separately evaluate factors associated with initiation of exenatide among patients with type 2 diabetes mellitus and differences between those who initiated exenatide with and without concurrent insulin use. Cohort 1 was used to assess predictors of exenatide initiation and included adults with type 2 diabetes who were active in the database when exenatide became available (October 1, 2005). Cohort 2 was used to identify characteristics of patients who initiated exenatide with and without insulin. Cohort 1 included 190 444 adults, and cohort 2 included 9810 adults. In cohort 1, 7383 patients initiated exenatide therapy; factors associated with exenatide initiation were female sex, younger age, body weight of 102.3 kg or greater, body mass index of 35 kg/m2 or greater, residence in the southern United States, a lower Charlson Comorbidity Index, previous or existing therapy with triple oral antidiabetic drugs, and insulin plus oral antidiabetic drugs. In cohort 2, 2470 exenatide-treated patients initiated exenatide with insulin (25%) (with or without oral antidiabetic drugs). They were more likely to weigh more than 113.6 kg, have a body mass index greater than 40 kg/m2, have a Charlson Comorbidity Index of 2 or greater, and have a baseline hemoglobin A1c level greater than 9%. Exenatide concomitant with insulin use (with or without oral antidiabetic drugs) was common, and was more likely to be prescribed in patients with morbid obesity, comorbid conditions, and poor glycemic control. Randomized controlled trials are needed to confirm the safe and effective use of this combination.

Effectiveness of Implantable Defibrillators in Octogenarians and Nonagenarians for Primary Prevention of Sudden Cardiac Death

Given their advanced age and frequent co-morbidities, it is unclear whether octogenarians and nonagenarians with decreased left ventricular ejection fraction (LVEF) derive a survival benefit from implantable cardioverter-defibrillators (ICDs) in the primary prevention setting. The purpose of this study was to examine the effect of ICDs, age, and multiple co-morbidities on survival in elderly patients who otherwise meet implantation criteria for primary prevention of sudden cardiac death. Patients ≥80 years of age who received an ICD for LVEF ≤35% at our institution from 2001 through 2008 (n = 99) were compared to a cohort of patients ≥80 years of age with similarly low LVEF who did not receive an ICD (n = 53). Co-morbid conditions were assessed using the Charlson co-morbidity index (CCI). The overall cohort (n = 152, 84 ± 4 years old, 72% men, 87% with ischemic cardiomyopathy, LVEF 25 ± 7%, CCI 5.9 ± 3.2) was followed for 2.3 ± 2.0 years. Patients with ICDs were younger (82 ± 3 vs 86 ± 4 years, p <0.001) and had fewer co-morbidities reflected in a lower CCI (5.3 ± 3.1 vs 6.7 ± 3.1, p = 0.021). Patients with ICDs also had a trend toward lower LVEF (24 ± 6% vs 27 ± 7%, p = 0.06). During follow-up 93 (61%) patients died, 58 (59%) in the ICD group and 35 (66%) in the no-ICD group. ICD recipients had better 1-year survival compared to patients with no ICD (72% vs 52%, p = 0.014). However, after adjusting for age, LVEF, glomerular filtration rate (GFR), and CCI using multivariate Cox models, an ICD did not confer any survival benefit (hazard ratio 0.71, 95% confidence interval 0.42 to 1.20, p = 0.20), whereas age (p = 0.043) and GFR (p = 0.006) were the only independent predictors of survival. In conclusion, age and GFR are the main determinant of survival in octogenarians and nonagenarians with LV dysfunction. After correcting for these parameters, an ICD does not appear to confer a survival benefit.

Peritoneal dialysis in polycystic kidney disease patients. Report from the French peritoneal dialysis registry (RDPLF)

It is commonly believed that polycystic kidney disease (PKD) patients on peritoneal dialysis (PD) are over-exposed to technique failure and peritonitis compared with other patients. This study was carried out to assess whether PKD is associated with technique failure and to evaluate the outcome of PKD patients on PD. This was a retrospective cohort study based on the data of the French Language Peritoneal Dialysis Registry. We analysed 4162 incident non-diabetic patients who started PD between January 2002 and December 2007. The end of the observation period was 31 December 2008. Among 4162 patients, there were 344 PKD patients and 3818 patients who had another underlying nephropathy. PKD patients were younger, had a lower Charlson comorbidity index, were more frequently treated by automated PD and were less frequently assisted than other patients. For the PKD patients, the main reason for PD cessation was renal transplantation. In the multivariate analysis, comorbidities and centre size were associated with technique survival, and no association between PKD and technique failure was observed. There was no statistically significant association between PKD and peritonitis or between PKD and enteric peritonitis. On multivariate analysis, patient survival was associated with PKD and with patient age, comorbidities and the modality of assistance. Centre size was not associated with patient survival. PD is a suitable method for at least a subgroup of PKD patients reaching end-stage renal disease in a country where renal transplantation is available.

Charlson Comorbidity Index Is An Independent Prognostic Factor Among Elderly Patients with Diffuse Large B-Cell Lymphoma (DLBCL).

Abstract 3923 Poster Board III-859 Introduction Wide use of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) has improved the clinical outcome for elderly patients with DLBCL; however, a higher prevalence of coexisting disorders remains a problem. Correlation between their comorbidities and prognosis has not yet been well investigated. Patients and methods We retrospectively analyzed all patients over 65 years old who had been newly diagnosed with DLBCL at our institution from 2001 to 2008. To assess their comorbid medical status, we calculated the Charlson Comorbidity Index (CCI) for patient excluding primary disease. Prognostic factors were identified by Cox proportional hazards regression model. We classified patients into a low CCI group (CCI 0-1) and a high CCI group (CCI 2 or higher). Kaplan-Meyer curves for each group were evaluated by logrank test. Results A total of 80 patients were enrolled in this analysis. The median age was 73 (range 66-90) and the median observation period was 28 months (range 4-90 months). 62 patients (77.5%) were treated with R-CHOP, 15 (18.6%) underwent some other regimen, and 3 (3.8%) were given best supportive care only. According to revised International Prognostic Index (r-IPI), 43 patients were in the good risk group and the others were in the poor risk group. The estimated 3 year over all survival (OS) rate for these groups were 90% and 45% (p&lt;0.0001). As for CCI, 14 patients (17.5%) were assigned to the high CCI group. Multivariate analysis revealed high CCI was associated with worse OS, while independent of r-IPI [Hazard Ratio (HR) 3.20, 95% Confidence interval (CI) 1.28-7.41, p=0.0145]. Among r-IPI poor risk patients, the high CCI group was inferior to the low CCI group for the 3 year OS rate (14% vs 56% p=0.0358), whereas this was not significant among r-IPI good risk patients (69% vs 94% p=0.0617). Conclusions Among elderly patients with DLBCL, high CCI is independently associated with poor survival. Patients having both poor r-IPI and high CCI may need discrete strategies. Disclosures: No relevant conflicts of interest to declare.

Comprehensive Analysis of Pulmonary Function Test (PFT) Changes After Stereotactic Body Radiotherapy (SBRT) for Stage I Lung Cancer in Medically Inoperable Patients

To assess for variables predicting pulmonary function test (PFT) changes after stereotactic body radiotherapy (SBRT) for medically inoperable stage I lung cancer. We reviewed 92 consecutive patients undergoing SBRT for stage I lung cancer between February 2004 and August 2007. A total of 102 lesions were treated using prescriptions of 20 Gy x 3 (n = 40), 10 Gy x 5 (n = 56), and 5 Gy x 10 (n = 6). Institutional practice was 10 Gy x 5 before March 1, 2006 before changing to 20 Gy x 3 to conform to RTOG 0236 unless otherwise dictated clinically. Median pretreatment forced expiratory volume at 1 second (FEV1) was 1.21 liter (50% of predicted) and median diffusion capacity to carbon monoxide (DLCO) was 56.5. There was no significant overall change in PFT's after SBRT. Individual patients experienced both substantial improvements and declines (10% declined at least 14% predicted FEV1% and 19% predicted DLCO). The mean change in FEV1 was -0.05 liter (range, -0.98 to +1.29 liter; p = 0.22) representing -1.88% predicted baseline FEV1 (range, -33 to + 43%; p = 0.62). DLCO declined 2.59% of predicted (range, -37 to +33%; p = 0.27). Conformality index, V5 and V10 were associated with individual patient changes in FEV1% (p = 0.033, p = 0.0036, p = 0.025, respectively), however, correlations were small and overall treatment dose did not predict for changes (p = 0.95). There was no significant difference in FEV1 (p = 0.55) or FEV1% (p = 0.37) changes for central versus peripheral locations. No factors predicted for individual changes in DLCO. Patients with FEV1% below the median of the study population had significantly longer overall survival (p = 0.0065). Although patients dying of cardiac disease died earlier than those dying of other causes, FEV1% below median was not associated with a lower risk of dying of cardiac disease or with lower Charlson comorbidity index. (1) SBRT was well tolerated and PFT changes were minimal. (2) Central lesions were safely treated with 50 Gy.

Opportunities for improving medication use and monitoring in gout

Purpose:To study patterns and predictors of medication use and laboratory monitoring in gout.Methods:In a cohort of veterans with a diagnosis of gout prescribed allopurinol, colchicine or probenecid, quality of care...

Sevelamer Hydrochloride in Peritoneal Dialysis Patients: Results of a Multicenter Cross-Sectional Study

Sevelamer hydrochloride is a phosphate binder widely employed in hemodialysis patients. Until now, information about its efficacy and safety in peritoneal dialysis patients has been scarce. In September 2005 a cross-sectional study of demographic, biochemical, and therapeutic data of patients from 10 peritoneal dialysis units in Catalonia and the Balearic Islands, Spain, was conducted. We analyzed data from 228 patients. At the time of the study, 128 patients (56%) were receiving sevelamer. Patients receiving sevelamer were younger (p < 0.01), showed a longer period of time on dialysis (p < 0.01), and had a lower Charlson Comorbidity Index (p < 0.01). Serum calcium and intact parathyroid hormone levels were not different between the two groups, while phosphate levels <5.5 mg/dL were observed more frequently in patients not receiving sevelamer (79% vs 61%, p < 0.01). Serum total cholesterol (167 +/- 41 vs 189 +/- 42 mg/dL, p < 0.01) and low density lipoprotein (LDL) cholesterol (90 +/- 34 vs 109 +/- 34 mg/dL, p < 0.01), but not high density lipoprotein cholesterol or triglycerides, were lower in sevelamer-treated patients. Moreover, sevelamer-treated patients displayed a higher serum albumin (38 +/- 5 vs 36 +/- 4 g/L, p < 0.01) and a lower C-reactive protein (4.9 +/- 12.8 vs 8.8 +/- 15.7 mg/L, p < 0.01). Blood bicarbonate levels <22 mmol/L were observed more frequently in patients receiving sevelamer (22% vs 5%, p < 0.01). Logistic regression analysis adjusting by confounding variables confirmed that sevelamer therapy was associated with serum total cholesterol <200 mg/dL [relative risk (RR): 2.77, 95% confidence interval (CI): 1.44 - 5.26, p = 0.002] and blood bicarbonate <22 mmol/L (RR: 8.5, 95% CI: 2.6 - 27.0, p < 0.001), but not with serum phosphate >5.5 mg/dL, calcium-phosphate product >55 mg(2)/dL(2), serum albumin <35 g/L, or C-reactive protein >5 mg/L. This uncontrolled cross-sectional study in peritoneal dialysis patients showed that sevelamer hydrochloride treatment allows an adequate serum phosphate level in about 60% of patients and significantly reduces total and LDL-cholesterol levels. Since this treatment is associated with metabolic acidosis in 22% of patients, we recommend close monitoring of bicarbonate levels in this group of patients until the clinical significance of this result is clarified.

Efecto hipolipemiante y antiinflamatorio del sevelamer en pacientes en diálisis peritoneal

Background Sevelamer hydrochloride is a non-absorbable, aluminium-and calcium-free ion-exchange resin with proven efficacy and safety in hemodialysis patients. However, until now, little information has been available on the efficacy and safety of this molecule in peritoneal dialysis patients. Patients and method We analyzed the effects of sevelamer hydrochloride through a cross-sectional study of 228 patients under peritoneal dialysis in 10 dialysis units in Catalonia and the Balearic Islands (Spain). Results At the time of the study, 56 % patients were receiving sevelamer. Patients receiving sevelamer were younger (p < 0.01), had been under dialysis for longer (p < 0.01) and had a lower Charlson comorbidity index (p < 0.01) than patients not receiving this drug. Serum calcium levels and intact parathyroid hormone (i-PTH) levels showed no differences between the 2 groups, while sevelamer-treated patients and higher levels of serum phosphate and calcium-phosphate product. Phosphate levels < 5.5 mg/dl were observed less frequently in patients receiving sevelamer (61 % vs. 79 %; p < 0.01). Total serum cholesterol (167 ± 41 vs. 189 ± 42 mg/dl; p < 0.0001) and low-density lipoprotein cholesterol (90 ± 34 vs. 109 ± 34 mg/dl; p < 0.0003) levels were lower in sevelamer-treated patients. Moreover, sevelamer-treated patients displayed higher serum albumin (38 ± 5 vs. 36 ± 4 g/l; p < 0.01) and lower C reactive protein (4.9 ± 12.8 vs. 8.8 ± 15.7 mg/l; p < 0.01) levels, revealing better nutritional and inflammatory status. Blood bicarbonate levels were lower in patients receiving sevelamer (24 ± 3.2 vs. 26.7 ± 3.2 mmol/l; p < 0.01). Conclusions Sevelamer hydrochloride treatment may have an anti-inflammatory effect in addition to improving lipid profile and achieving good phosphate levels, similar to those achieved in patients under hemodialysis. We recommend close monitoring of bicarbonate levels in this group of patients.