Mortality In Chronic Peritoneal Dialysis Patients Research Articles

Geriatric nutritional risk index is associated with mortality in peritoneal dialysis patients

Malnutrition is one of the most common complications among dialysis patients. The Geriatric Nutritional Risk Index (GNRI) is rarely used in dialysis patients, especially peritoneal dialysis (PD). To use the GNRI to evaluate the initial nutritional state of PD patients and to examine the association between the GNRI and mortality in chronic PD patients. We retrospectively examined the medical records at our centre to identify all adults (≥18 years) who had undergone PD for over 3 months before recruitment from January 2005 to December 2017. The correlation between the GNRI and mortality was examined by Kaplan-Meier and Cox proportional hazards analyses. A total of 1804 patients was enrolled in the study. Significant correlations were noted between the initial GNRI and Charlson index, uric acid, blood calcium, potassium, triglycerides, low-density lipoprotein cholesterol, haemoglobin and so on. Multivariate Cox proportional hazards analyses demonstrated that the GNRI was associated with all-cause mortality (hazard ratio = 0.96, P < 0.001, 95% confidence interval: 0.95-0.98) after adjustment. Compared with the lowest GNRI group, all-cause mortality decreased significantly for each level of GNRI after adjusting for various influencing factors, and the mortality risk of the highest GNRI grade decreased by 66%. The Kaplan-Meier analysis survival rate was significantly different among the four groups in terms of all-cause mortality and cardiovascular and cerebrovascular mortality (log-rank test, P < 0.05). These results demonstrated that the GNRI is significantly associated with mortality and can be a simple, clinically useful marker for the assessment of nutritional status in PD patients.

Prolonged QT interval is linked to all-cause and cardiac mortality in chronic peritoneal dialysis patients.

Prolonged QT interval is related to changes of electrolytes in haemodialysis (HD) and is associated with all-cause mortality in HD patients. It is unknown if prolonged QT interval is associated with all-cause mortality in peritoneal dialysis (PD) patients as the electrolytes were relatively stable in PD. We therefore investigated the association of prolonged QT interval and all-cause mortality in chronic PD patients. The QT intervals were measured in 2003 and all patients were followed to December 2012. A prolonged QT interval was defined as a QT interval > 450 ms. The association of prolonged QT interval with all-cause and cardiac-specific mortality was analyzed using Cox regression and Kaplan-Meier analysis. Of 306 patients, 196 (64%) patients had prolonged QT interval. The incidence density rate was 9.7 per 100 persons-years for all-cause mortality and 5.6 for cardiac specific mortality in patients with prolonged QT interval. Prolonged QT interval was associated with all-cause mortality with a hazard ratio (HR) of 1.59 (95% confidence interval (CI): 1.06-2.39, P = 0.03] and cardiac mortality (HR: 1.66, 95% CI: 1.00-2.78, P = 0.05) with adjustments for age, gender, diabetes, and vintage of dialysis. Longer QT interval (>500 ms, 450-500 ms, and < 450 ms) was significantly associated with a worse overall survival (P = 0.03, log-rank test) and cardiac mortality free survival (P = 0.05, log-rank test). Prolonged QT interval was associated with all-cause and cardiac mortality in patients on peritoneal dialysis. The association is independent of patient's age and diabetes.

Association Between Blood Cadmium Levels and Mortality in Peritoneal Dialysis.

The negative impact of environmental exposure of cadmium has been well established in the general population. However, the effect of cadmium exposure in chronic peritoneal dialysis (PD) patients remains uncertain.A total of 306 chronic PD patients were included in this 36-month observational study. Patients were stratified into 3 groups by the tertile of baseline blood cadmium levels (BCLs): high (>0.244 μg/L, n = 101), middle (0.130–0.244 μg/L, n = 102), and low (<0.130 μg/L, n = 103) for cross-sectional analyses. Mortality rates and cause of death were recorded for longitudinal analyses.Patients in the high-BCL group were older, more likely to have diabetes mellitus, had lower levels of serum albumin and lower percentage of lean body mass than patients in the low-BCL group. A multivariate logistic regression analysis revealed that logarithmic transformed BCL was independently associated with a higher risk of low turnover bone disease (odds ratio = 3.8, P = 0.005). At the end of the 36-month follow-up, 66 (21.6%) patients died. Mortality rates increased with higher BCLs (P for trend = 0.005). A Cox multivariate analysis showed that, using the low-BCL group as the reference, the high-BCL group had increased hazard ratios (HR) for all-cause mortality in chronic PD patients after adjusting for related variables (HR = 2.469, 95% confidence interval = 1.078–5.650, P = 0.043).In conclusion, BCL showed significant association with malnutrition and low turnover bone disease in chronic PD patients. Furthermore, BCL is an important determinant of mortality. Our findings suggest that avoiding environmental exposure to cadmium as much as possible is warranted in chronic PD patients.

Baseline hyponatremia does not predict two-year mortality in patients with chronic peritoneal dialysis

Purpose: Hyponatremia is a common electrolyte abnormality in a variety of medical conditions. Lower predialysis serum sodium concentration is associated with an increased risk of death in oligoanuric patients on hemodialysis. However, whether hyponatremia affects the short-term mortality in chronic peritoneal dialysis (CPD) patients remains unclear. Methods: We conducted a cross-sectional and two-year follow-up review retrospectively, and 318 patients with CPD were enrolled in a medical center. Serum sodium levels were measured at baseline and categorized as quartile of Na: quartile 1 (124–135 mEq/L), quartile 2 (136–139), quartile 3 (140–141) and quartile 4 (142–148). Mortality and cause of death were recorded for longitudinal analyses. Results: The patients with higher quartile (higher serum sodium) had a trend of lower age, peritoneal dialysis (PD) duration, co-morbidity index, D/P Cr and white blood cell counts and higher renal Kt/Vurea (Kt/V) and serum albumin level. Stepwise multiple linear regression analysis showed that serum sodium level was positively associated with albumin, residual renal Kt/V and negatively associated with age and PD duration in CPD patients. After two-year follow-up, stepwise multivariate Cox proportional hazards model demonstrated that age, co-morbidity index and serum albumin were the significant risk factors for all-cause two-year mortality, but not serum sodium levels. Conclusions: Serum sodium level in CPD patients is associated with nutritional status, residual renal function and duration of PD. However, baseline serum sodium level is not an independent predictor of two-year mortality in CPD patients.

Blood lead levels association with 18-month all-cause mortality in patients with chronic peritoneal dialysis

The clinical significance of blood lead levels (BLLs) in chronic peritoneal dialysis (CPD) patients was undetermined prior to this study. A total of 315 patients on CPD were included in this 18-month prospective study. BLLs measured at baseline were categorized according to a BLL tertile of high (>8.66 microg/dL), middle (5.62-8.66 microg/dL) and low (<5.62 microg/dL) for cross-sectional analyses. Mortality and cause of death were recorded for longitudinal analyses. At baseline, patients with high BLLs had a trend of higher parathyroid hormone and lower residual renal function than patients in other groups. Stepwise multiple regression analysis found that parathyroid hormone positively correlated and residual renal function negatively correlated with logarithmic-transformed BLLs in CPD patients after other confounders were adjusted. At the end of follow-up, 37 (11.7%) patients had died. Kaplan-Meier analysis showed that patients with high BLLs had greater mortality than those with middle and low BLLs (P = 0.008). Cox multivariate analysis showed that, using the low BLL group as the reference, basal high BLLs (hazard ratio [HR] = 3.745, 95% confidence interval [95% CI] = 1.218-11.494, P = 0.001) and middle BLLs (HR = 1.867, 95% CI = 1.618-2.567, P = 0.001) were associated with increased HR for all-cause mortality for CPD patients. There is a significant trend (P < 0.001) of HR for mortality trend tests among the three study groups. BLLs are associated with residual renal function and hyperparathyroidism and are related to increased HR for all-cause 18-month mortality in CPD patients.