Mortality In Peritoneal Dialysis Patients Research Articles

Prognostic significance of carotid plaque presence in peritoneal dialysis patients and its association with the apolipoprotein B/apolipoprotein A1 ratio.

Atherosclerosis has been reported as a risk factor for cardiovascular disease in the general population. As a phenotype of atherosclerosis, carotid plaque and its influence factors are rarely discussed among dialysis patients. The study aimed to investigate the prognosis-predictive significance of carotid plaques in patients on peritoneal dialysis (PD), and explore risks factors for carotid plaque presence. It was an observational, prospective study. Patients that had undergone stable PD for at least 3 months were recruited and divided into two subgroups: group with carotid plaques and group without carotid plaques. Cox regression model was used to identify independent predictors of all-cause mortality, cardiovascular events (CVEs), and cardiovascular mortality. Pathogenic factors correlated to the plaque-occurrence were explored by logistic regression and verified by receiver operating characteristic (ROC) curve analysis. A total of 233 PD patients were recruited. The cohort was followed for up to 86 months. The carotid plaque presence turned out to be an independent risk factor both of CVEs [hazard ratio (HR): 2.659; 95% confidence interval (CI): 1.231-5.741; P = .013] and cardiovascular mortality (HR: 3.716; 95% CI: 1.168-11.823; P = .026). The apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) ratio was significantly associated with the presence of carotid plaques. ROC analysis indicated that the area under the curve of the ApoB/ApoA1 ratio was higher than that of the traditional lipid metabolism index for detecting plaque presence. Carotid plaque presence can predict CVEs and cardiovascular mortality in PD patients. The ApoB/ApoA1 ratio is significantly correlated to the carotid plaques and the ApoB/ApoA1 ratio had a greater sensitivity than traditional lipid indices for predicting plaque presence.

Elevated TG/HDL-C and non-HDL-C/HDL-C ratios predict mortality in peritoneal dialysis patients

Background and aimsDyslipidemia is common in patients with chronic kidney disease and particular prevalent in patients receiving peritoneal dialysis. However, whether markers of atherogenic dyslipidemia correlate with outcomes in dialysis patients as in the general population is uncertain. The aim of this study was to explore the prognostic value of the serum triglyceride/HDL cholesterol (TG/HDL-C) ratio and non-HDL-C/HDL-C ratio to predict mortality in peritoneal dialysis patients.MethodsTwo hundred fourteen peritoneal dialysis patients were retrospectively analyzed from January 2011 to December 2015, with a median follow-up of 59 months. We used receiver operating curves (ROC) to determine the optimal threshold for TG/HDL-C and non-HDL/HDL-C ratios at baseline to predict overall survival during follow-up. Prognostic values were accessed by univariate and multivariate COX regression analysis and Kaplan-Meier curve. A predictive nomogram was developed to predict prognosis for overall survival, and the predictive accuracy was evaluated by concordance index (c-index).ResultsThe optimal cut-off values for TG/HDL-C ratio and non-HDL-C/HDL-C ratio to predict mortality were 1.94 and 2.86, respectively. A high TG/HDL-C ratio and a high non-HDL-C/HDL-C ratio strongly correlated with worse overall survival in peritoneal dialysis patients. Multivariate analysis demonstrated that elevated TG/HDL-C ratio (HR 3.57, 95% CI 1.99, 6.39, P < 0.000) as well as non-HDL/HDL-C ratio (HR 2.58, 95%CI 1.39–4.81, P = 0.003) were independent markers to predict reduced OS. A nomogram was constructed to predict overall survival, with a c-index for predictive accuracy of 0.795.ConclusionTG/HDL-C ratio and non-HDL-C/HDL-C may serve as potential prognostic biomarkers in PD patients.

The associations of blood pressure parameters with all-cause and cardiovascular mortality in peritoneal dialysis patients: a cohort study in China.

It remains controversial to claim blood pressure (BP) as a leading risk factor for high risk of death in peritoneal dialysis patients, and less is known about the relationship between BP and mortality in Chinese peritoneal dialysis patients. From Zhejiang Renal Data System in China, we collected data on patients treated and followed up at 98 peritoneal dialysis centres from 2008 to 2016. The associations of BP parameters [SBP, DBP, mean arterial pressure (MAP) and pulse pressure (PP)] with all-cause and cardiovascular mortality were examined. We fitted Cox models for mortality with penalized splines using nonparametric smoothers. Several sensitivity analyses were performed to confirm the robustness of our primary findings. A total of 7335 Chinese peritoneal dialysis patients were included. During a median follow-up of 35.8 months, 1281 (17.5%) patients died. SBP, DBP, MAP follow a U-shaped pattern of both all-cause and cardiovascular mortality. PP presents a reverse L-shaped association with all-cause mortality. Either a higher (SBP >141, DBP >85 or MAP >102 mmHg) or lower (SBP <119, DBP <67 or MAP <88 mmHg) BP tends to have a significantly higher all-cause and cardiovascular mortality risk. Higher PP (>60 mmHg) is related to a higher risk of all-cause mortality, but not cardiovascular mortality. These associations remain the same in our competing risk analysis and subgroup analyses. These data indicate U-shaped associations of SBP, DBP and MAP with all-cause mortality and cardiovascular mortality, respectively, and a reverse L-shaped association of PP with all-cause mortality. Further studies are needed to reliably establish the optimal BP targets for better hypertension control in peritoneal dialysis patients.

Systemic inflammation modulates the ability of serum ferritin to predict all-cause and cardiovascular mortality in peritoneal dialysis patients

BackgroundThis study aimed to ascertain whether the correlation of high serum ferritin with mortality is affected by systemic inflammation and to investigate the optimal serum ferritin level for predicting death when inflammation is considered in peritoneal dialysis (PD) patients.MethodsWe classified 221 patients into four groups according to serum ferritin concentration (100 μg/L) and high-sensitivity CRP (hs-CRP) level (3 mg/L), and followed them regularly from the date of catheterization to Dec 31, 2016, at Sun Yat-Sen Memorial Hospital, China. Clinical and biochemical data were collected at baseline, and clinical outcomes such as all-cause and cardiovascular mortality were assessed.ResultsDuring a median follow-up of 35 months (3 ~ 109 months), 50 (22.6%) deaths occurred. Cardiovascular disease (46.0%) was the most common cause of death, followed by infection (10.0%). The Kaplan–Meier survival analysis and log-rank test revealed significantly worse survival accumulation among PD patients with higher serum ferritin (≥100 μg/L) under elevated hsCRP levels (> 3 mg/L) (P = 0.022). A multivariate Cox regression analysis revealed that an increased serum ferritin level was independently associated with a higher risk of all-cause and cardiovascular mortality in PD patients (HR = 3.114, P = 0.021; and HR = 9.382, P = 0.032) with hsCRP above 3 mg/L after adjusting for relevant confounding factors.ConclusionHigher serum ferritin levels were associated with an increased risk of all-cause and cardiovascular mortality in patients undergoing PD only in the presence of elevated hsCRP levels. The correlation of serum ferritin with poor outcome should take into consideration systemic inflammation.

P1168ABDOMINAL AORTIC CALCIFICATION SCORE MODIFIES THE PROGNOSTIC VALUE OF SERUM MAGNESIUM LEVELS ON ALL CAUSE MORTALITY IN PERITONEAL DIALYSIS PATIENTS

Abstract Background and Aims Low serum Mg (s-Mg) concentration has been associated with an increased risk of death in both the general and dialysis populations. In peritoneal dialysis (PD) patients, an inverse correlation between s-Mg and abdominal aortic calcification (AAC), estimated by plain lateral lumbar x-rays, as Leena Kauppila (LK) score (range 0-24), is well documented. LK score of 0-4 has been associated with the best event free survival (CORD study CJASN 2011). Here, we explored the possibility whether AAC could modify the relationship between s-Mg and all-cause mortality in PD patients. Method We studied 95 stable PD patients, 51 men 44 women, with a mean age of 63 ±14 years. The degree of AAC was evaluated with on plain lateral abdominal radiographs, as LK score. After completion of baseline assessment, including s-Mg measurements, patients were followed up for all-cause mortality. Results The mean of s-Mg and AAC in the whole group were 2.25±0.47 mg/dl and 6.65 ± 5.94 respectively. There was an strong inverse correlation (rho = -0.225; p=0.029) between s-Mg and AAC. During a median follow-up period of 23 months, 16 (17%) deaths occurred. There was a 78% reduction of all-cause mortality for every 1 mg/dl of increase in s-Mg {crude HR: 0.22 (95% CI, 0.06 - 0.78)}. An interacting effect between s-Mg and AAC was significant (p=0.005) after controlling for main effects. Then, the association between s-Mg and all-cause mortality by subgroups of AAC: higher tertile vs all lower, was examined (cut-offs of the tertiles for AAC were 3 and 9). In patients grouped in the lower tertiles, s-Mg was a significant predictor of all-cause mortality, even after adjustment for univariate significant predictors of all-cause mortality: age, cardiovascular disease, PD vintage and malnutrition-inflammation score (MIS) {adjusted HR: 0.14 (95% CI, 0.02-0.0.98)}. On the contrary, patients with AAC in the higher tertile of the baseline distribution, s-Mg levels were not predictive of outcome in either crude or the adjusted models. Conclusion The predictive value of s-Mg in all-cause mortality in PD patients appears to be critically dependent on AAC score. Thus, sustaining higher sMg levels, as by using higher Mg dialysate concentration, may have beneficial effects on clinical outcomes only in patients without AAC or at least in those with early lesion development.

High alkaline phosphatase and low intact parathyroid hormone associate with worse clinical outcome in peritoneal dialysis patients.

Alkaline phosphatase (ALP) is used as a biomarker to monitor the chronic kidney disease-mineral bone disorder (CKD-MBD) and high levels of parathyroid hormone (PTH) that were reported to be related to increased mortality in CKD patients. Therefore, we conducted this longitudinal cohort study to evaluate the relations between ALP and intact PTH (iPTH) and the associations with all-cause and cardiovascular mortality in peritoneal dialysis (PD) patients. In 1276 incident PD patients (median age 50 years, 56% males), baseline serum ALP, iPTH, and metabolic biomarkers potentially linked to CKD-MBD were analyzed in relation to mortality during follow-up period of up to 60 months. All-cause and cardiovascular mortality risk of ALP and iPTH were analyzed with competing-risks regression models with transplantation as competing risk adjusting for all covariates. After adjustments for confounders by logistic regression model, older age, higher change level to levels of iPTH, S-albumin, calcium, alanine transaminase (ALT), and lower level of phosphorus were associated with higher ALP level (>79 U/L), and female gender, non-diabetes mellitus, younger age, lower calcium, higher ALT, total bilirubin, phosphorus, and ALP were associated with higher iPTH level (>300 pg/mL). During 60 months (median 44 months) of follow-up, the all-cause mortality rate was 16%, and 91 (46%) of the 199 deaths were caused by cardiovascular disease. In competing-risks regression analysis, "high ALP + low iPTH" was independently associated with all-cause and cardiovascular mortality after adjustment for age, gender, presence of diabetes, and cardiovascular disease, the calendar year of recruitment and vitamin D therapy in PD patients. The subhazard ratio (sHR) of group "high ALP + low iPTH" was 1.96 times and 3.35 times higher than sHR of group "low ALP + high iPTH" for all-cause mortality and cardiovascular mortality, respectively. The combination of high ALP and low iPTH was independently associated with increased all-cause and cardiovascular mortality in PD patients, suggesting that ALP and iPTH have the potential to predict clinical outcomes and might be useful risk assessment tools in PD patients. Further studies exploring the observed association between combination of ALP with iPTH and mortality are warranted.

Longitudinal changes in body composition are associated with all-cause mortality in patients on peritoneal dialysis.

Peritoneal dialysis (PD) is associated with a number of adverse body compositional changes, including fat gain and muscle wasting. Whether body compositional changes are associated with the long-term prognosis is uncertain. The purpose of this study was to analyze the effects of longitudinal changes in body composition on all-cause mortality in PD patients. PD patients were subjected to bioimpedance spectroscopy (BIS) and handgrip strength (HGS) at baseline and after 2 years. Among 160 patients, 131 patients were tested with a repeat BIS and HGS. Lean tissue index (LTI) loss and fat tissue index (FTI) gain were defined as a 10% decline in LTI and a 10% gain in FTI, respectively after 2 years. The prevalence of sarcopenia at baseline was 13.8%. After 2 years, LTI loss and FTI gain were observed in 40 (30.5%) and 58 (44.3%) patients, respectively. Baseline clinical factors did not predict longitudinal body compositional changes, and there was a negative association between changes in the LTI and FTI (r=-0.574, p<0.001). Low LTI and low HGS at baseline were significant predictors of all-cause mortality after adjusting for demographic and biochemical parameters, but not when cardiovascular factors were included in the multivariate analysis. However, LTI loss and FTI gain were independent risk factors for all-cause mortality after adjusting for demographic, biochemical, and cardiovascular parameters. In PD patients, longitudinal changes in LTI and FTI were more strongly associated with all-cause mortality than single values in LTI and FTI.

Long-term clinical outcomes of peritoneal dialysis patients: 9-year experience of a single centre in Turkey

Background/aim The aim of this study was to evaluate the clinical outcomes and identify the predictors of mortality in peritoneal dialysis patients.Materials and methods Medical records of all incident peritoneal dialysis (PD) patients followed up between January 2011 and May 2019 were reviewed retrospectively. All patients were followed up until death, renal transplantation, transfer to haemodialysis or the end of the study. Results A total of 242 patients were included in the study. The incidence of peritonitis was 0.18 (ranging from 0 to 14.9) episodes per patient year. Death occurred in 28% (n: 68) of cases. Age, diabetes mellitus, malignancy and refractory heart failure were independent risk factors for all-cause mortality according to multivariate analysis. The presence of comorbid disease and diabetes mellitus and patients aged > 65 years were associated with increased risk of mortality and decreased patient survival. Peritonitis history was associated with increased risk of mortality. Between peritonitis and peritonitis-free group, there was no significant difference in Kaplan-Meier curves in terms of patient survival. Conclusion This is the first study to define 9-year mortality predictors in PD patients in our centre. Although peritonitis is the most feared complication of PD, our study showed that peritonitis did not reduce patient survival.

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.

The associations of plant-based protein intake with all-cause and cardiovascular mortality in patients on peritoneal dialysis

Background and aimsPlant-based protein intake is associated with all-cause and/or cardiovascular disease (CVD) mortality in general population, but such data are scarce in dialysis patients. Thus, we examined the associations of plant-based protein–total protein ratio with all-cause and CVD mortality in patients on peritoneal dialysis (PD). Methods and resultsThe study enrolled 884 incident patients who started PD between October 2002 and August 2014. All demographic and laboratory data were recorded at baseline. Repeated measurements for laboratory and nutrition parameters were recorded at regular intervals and thus calculated as time-averaged values. Multivariable Cox regression models were used to estimate the hazard ratio (HR) of plant-based protein–total protein ratio and mortality based on baseline and time-averaged covariates, respectively. There were 437 (49%) patients died during a mean follow-up period of 45 months, of which 178 (40.8%) were due to CVD. Each 10% in increase in time-averaged plant-based protein–total protein ratio was associated with a reduction of 71% (95% CI, 90%–14%) and 89% (95% CI, 98%–29%) for all-cause and CVD mortality, respectively. Based on examination on interactive effects, we further found both baseline and time-averaged plant-based protein–total protein ratio were inversely associated with all-cause and CVD mortality in the subgroups of female, age ≥60 years, and albumin >35 g/L. ConclusionsThe present study suggested that a diet with a higher plant-based protein–total protein ratio is associated with lower all-cause and CVD mortality in PD patients, and is more significant in female and elderly patients, and those without hypoalbuminemia.

Monocyte/Lymphocyte Ratio and Cardiovascular Disease Mortality in Peritoneal Dialysis Patients.

Objectives The monocyte-to-lymphocyte ratio (MLR), as a new marker of the systemic inflammatory response, is associated with cardiovascular disease (CVD) mortality in the general population and hemodialysis patients. However, the association between the MLR and CVD mortality in peritoneal dialysis (PD) has received little attention. Methods In this multicenter retrospective cohort study, 1753 incident PD patients from November 1, 2005, to June 30, 2017, with a baseline MLR were enrolled. The primary endpoint was CVD mortality. The association of MLR with CVD mortality was assessed using a multivariable-adjusted Cox model and the Fine and Gray competing risk model. Results Of 1753 patients, the mean age was 51.1 ± 14.9 years, 56.9% of patients were male, and the Charlson comorbidity index was 4.29 ± 1.75. During the follow-up period of 31.2 ± 18.4 months, 368 patients died, of which 200 (54.3%) deaths were caused by CVD events. CVD mortality rates for the lowest, middle, and highest MLR tertiles were 70.6, 78.4, and 88.9 per 1000 patient-years, respectively (P < 0.001). Kaplan-Meier analysis revealed that survival rates were significantly different among the three MLR groups (log rank = 22.41, P < 0.001). Kaplan-Meier analysis revealed that survival rates were significantly different among the three MLR groups (log rank = 22.41, P < 0.001). Kaplan-Meier analysis revealed that survival rates were significantly different among the three MLR groups (log rank = 22.41, P < 0.001). Kaplan-Meier analysis revealed that survival rates were significantly different among the three MLR groups (log rank = 22.41, P < 0.001). After adjusting for confounding factors, the highest MLR tertile was significantly associated with a hazard ratio (HR) for CVD mortality of 1.45 (95% confidence interval, 1.13-2.51, P = 0.016). The Fine and Gray method analysis showed that using all-cause mortality as competing risk, the highest MLR tertile remained an independent predictor of CVD mortality (HR = 1.39, 95% CI 1.10-2.47, P = 0.021). Conclusions Higher MLR levels at the commencement of PD may be independently associated with increased CVD mortality in PD patients.

Serum lipoprotein(a) and risk of mortality in patients on peritoneal dialysis

Elevated serum lipoprotein(a) [Lp(a)] level is an independent risk factor for atherosclerotic diseases in the general population and hemodialysis patients. However, the association between Lp(a) levels and mortality has received little attention in peritoneal dialysis (PD) patients. The objective of the study was to evaluate the association of Lp(a) levels with all-cause and cardiovascular (CV) mortality in PD patients. This retrospective cohort study was conducted in PD patients enrolled from January 1, 2006 to December 31, 2015, and followed until December 31, 2018. Cox regression models were performed to assess the association of serum Lp(a) levels with all-cause and CV mortality in PD patients. In total, 1492 incident PD patients were eligible for the study. During a median follow-up period of 45.1months, 402 all-cause and 210 CV deaths occurred. Multivariate Cox regression analysis revealed that the first and third tertiles of Lp(a) levels were significantly associated with increased risk for all-cause mortality [hazard ratio (HR)=1.33, 95% confidence interval (95% CI)=1.01-1.75, P=.041; HR=1.53, 95% CI=1.18-1.98, P=.001, respectively] when compared with the second tertile, and the third tertile of Lp(a) level was independently associated with an 80% increased risk of CV mortality (HR=1.80, 95% CI=1.26-2.56, P=.001). Moreover, our results showed that the HRs per log unit higher Lp(a) level for all-cause and CV mortality were 1.53 (95% CI=1.05-2.22, P=.027) and 2.41 (95% CI=1.44-4.03, P<.001), respectively. Our results suggest that both low and high serum Lp(a) levels are risk markers for all-cause death, but only a higher baseline serum Lp(a) level is an independent risk factor for CV mortality in PD patients.

Age Difference in the Association between Hyponatremia and Infection-Related Mortality in Peritoneal Dialysis Patients

Objectives: This study aimed to examine the association of serum sodium with infection-related mortality and its age difference among continuous ambulatory peritoneal dialysis (CAPD) patients. Methods: A total of 1,656 CAPD patients from January 2006 to December 2013 were included in this study. All patients were followed up until December 2018. Hyponatremia was defined as serum sodium <135 mmol/L. Cox proportional hazards regression model was used to investigate the relationship between baseline serum sodium levels and infection-related mortality. Results: Participants were aged 47.5 ± 15.3 years, 666 (40.2%) patients were female. Glomerulonephritis was the main cause of end-stage renal disease (61.1%). After a median of 46 months of follow-up, 507 patients died. Among the deaths, 252 (49.7%) died from cardiovascular diseases, 105 (20.7%) from infections, and 150 (29.6%) from other causes. The overall infection-related mortality was 14.8 events per 1,000 patients-year, which was higher in patients aged ≥50 years than those younger than 50 years (28.3 vs. 5.3 events per 1,000 patients-year). In the entire cohort, hyponatremia at was not associated with infection-related (hazards ratios [HR] 1.66, 95% CI 0.91–3.02) and all-cause mortality (HR 1.14, 95% CI 0.83–1.57) after adjusting for potential confounders. There was a significant interaction by age of association of serum sodium with infection-related (p = 0.002) and all-cause (p = 0.0002) death. Age-stratified analysis showed that compared with control group, hyponatremia was independently related to increased risks of infection-related death, but not all-cause mortality in patients aged ≥50 years, with HR of 2.32 (95% CI 1.25–4.32) and 1.33 (95% CI 0.95–1.87), respectively. Conclusions: Hyponatremia was associated with increased risk of infection-related mortality in CAPD patients aged ≥50 years.

Serum Prealbumin and Echocardiography Parameters Predict Mortality in Peritoneal Dialysis Patients

Aim: Protein-energy malnutrition and cardiovascular (CV) disease predisposes patients with end-stage renal disease (ESRD) on dialysis to a high risk of early death, but the prognostic value of prealbumin (PAB) and echocardiographic indices in ESRD patients treated with maintenance peritoneal dialysis (PD) remains unclear. Methods: A total of 211 PD patients (mean age 49.2 ± 15.4 years, 51.7% male) were prospectively studied. PAB and echocardiography parameters were recorded at baseline. Follow-up (mean ± SD: 33.7 ± 17.3 months) was conducted based on hospital records, clinic visits, and telephone reviews, to record death events and their causes. Results: In the Cox proportional hazards model, PAB and the echocardiographic parameters listed below were found to be optimal predictors of all-cause mortality: PAB (p = 0.003), aortic root diameter (ARD) (p = 0.004), interventricular septum end-diastolic thickness (IVSd) (p = 0.046), and left ventricular end-diastolic diameter index (LVEDDI) (p = 0.029). Of the above-mentioned factors, PAB (p = 0.018), ARD (p = 0.031), and IVSd (p = 0.037) were independent predictors of CV mortality in PD patients. Of note, malnutrition, degradation of the aorta, and myocardial hypertrophy are also known death risk factors in the general population. The all-cause mortality and CV death rate significantly increased as the number of risk factors increased, reaching values as high as 40 and 22% in patients who had all of the risk factors, i.e., abnormal PAB, ARD, and IVSd (p < 0.001 and p = 0.011). Conclusion: In PD patients, low serum PAB and abnormal echocardiographic parameters together were significantly associated with all-cause mortality and CV death, independently of other risk factors. These risk factors for death in PD are similar to those in the general population. Noticeably, the combination of echocardiographic parameters and PAB could provide additional predictive value for mortality in PD patients. In light of these findings, more studies in an optimal model containing PAB and echocardiographic parameters for the prediction of outcomes in ESRD are required.

The Association between Serum Uric Acid and Appendicular Skeletal Muscle Mass and the Effect of Their Interaction on Mortality in Patients on Peritoneal Dialysis

Background: Serum uric acid (SUA) has been revealed to be positively associated with the body composition parameters in hemodialysis patients, but few studies have investigated that in patients on peritoneal dialysis (PD). The aim of this study was to identify the relationship between SUA and appendicular skeletal muscle mass (ASM) and the effect of their interaction on mortality in PD patients. Methods: This was a single-center retrospective cohort study. Patients who underwent multifrequency bioelectrical impedance analysis between January 1, 2013, and December 31, 2016, and had data on SUA values were enrolled. All patients were followed up until December 31, 2019. Results: In total, 802 prevalent PD patients (57.9% male), with mean age of 46.2 ± 14.2 years were enrolled. The average SUA and ASM were 6.8 ± 1.3 mg/dL and 21.2 ± 4.9 kg. According to multiple linear regression models, SUA was positively associated with relative ASM in middle-aged and older PD patients (standardized coefficients [β] 0.117; 95% confidence interval [CI] 0.027, 0.200; p = 0.010). Further sex-stratified analysis showed that the association existed only in males (β 0.161; 95% CI 0.017, 0.227; p = 0.023). Moreover, the presence of hyperuricemia was found to predict lower risk of all-cause mortality (hazard ratio [HR] 0.514, 95% CI 0.272, 0.970; p = 0.040) only in patients with lower relative ASM. And, the adjusted HR of every 1 mg/dL elevated SUA level was 0.770 (95% CI 0.609, 0.972; p = 0.028) for all-cause mortality in the lower relative ASM subgroup. Conclusions: There exists a positive association between the SUA and ASM, and the ASM significantly affected the association between SUA and all-cause PD mortality.

Continuous Ambulatory Peritoneal Dialysis Peritonitis: Microbiology and Outcomes

AbstractContext: Continuous ambulatory peritoneal dialysis (CAPD) is now a preferred mode of the treatment in patients with end-stage renal disease, but peritonitis remains to be a shortcoming of CAPD. High-culture negativity, emerging drug resistance and peritoneal dialysis (PD)-related morbidity and mortality have been a challenge to tackle. Aims: The present study was taken up to compare the the various culture methods and to identify the spectrum of organisms causing CAPD peritonitis and their outcome. Settings and Design: A prospective, observational, cross-sectional study was conducted at a tertiary care teaching hospital in Hyderabad over a period of 1 year. Subjects and Methods: Dialysate fluid from 100 episodes of clinically suspected peritonitis in 75 patients was processed by conventional centrifuging, water lysis, direct inoculation and addition of centrifuged pellet into brain–heart infusion broth and by automated blood culture system. Identification and antibiotic susceptibility of organisms was done, and the outcome of PD-related peritonitis was analysed. Statistical Analysis Used: The categorical data and continuous data were analysed using the Chi-square test and Student’s t-test, respectively. P < 0.05 was considered statistically significant. Results: Of the 100 PD fluids, 87 were culture positive. Automated blood culture systems detected 87 episodes, whereas conventional centrifuge method detected only 53 episodes (P = 0.00001). Peritonitis due to Gram-negative organisms (62.3%) was higher than that of Gram-positive peritonitis (31.1%) and fungi (6.4%). Nineteen per cent episodes were constituted by relapse (9), refractory (4), recurrent (4) and repeat (2) peritonitis. Outcomes were analysed as recovery (77%), catheter removal (15%) and death (2.6%). Conclusions: Direct inoculation of peritoneal fluid into automated blood culture bottles increases the positivity rate and also aids in the early detection of CAPD peritonitis, helping reduce morbidity and mortality of PD patients.

Abdominal aortic calcification is superior to other arteries calcification in predicting the mortality in peritoneal dialysis patients \u2013 a 8\u2009years cohort study

BackgroundIn recent years, there has been a growing concern that abdominal aortic calcification (AAC) has a predictive effect on the prognosis of patients with end-stage renal disease (ESRD). However, whether other vascular calcification (VC) can predict the occurrence of adverse events in patients, and whether it is necessary to assess the calcification of other blood vessels remains controversial. This study aimed to assess VC in different sites using X-ray films, and to investigate the predictive effects of VC at different sites on all-cause mortality and cardiovascular (CV) mortality in peritoneal dialysis (PD) patients.MethodsThe data of Radiographs (lateral abdominal plain film, frontal pelvic radiograph and both hands radiograph) were collected to evaluate the calcification of abdominal aorta, iliac artery, femoral artery, radial artery, and finger arteries. Patients’ demographic data, clinical characteristics, laboratory data were recorded. The total follow-up period was 8 years, and the time and cause of death were recorded. Survival curves were estimated using Kaplan-Meier analysis. COX regression analysis was used to examine independent predictors of all-cause mortality and CV mortality.ResultsOne hundred fifty PD patients were included, a total of 79 patients (52.7%) died at the end of follow-up. After adjusting variables in the multivariate COX regression analysis, AAC was an independent predictor of all-cause mortality in PD patients (HR = 2.089, 95% CI: 1.089–4.042, P = 0.029), and was also an independent predictor of CV mortality (HR = 4.660, 95% CI: 1.852–11.725, P = 0.001). We also found that femoral artery calcification had a predictive effect on all-cause and CV mortality. But the calcification in iliac artery, radial artery, and finger arteries were not independent predictors of patients’ all-cause and CV mortality in PD patients.ConclusionAAC was more common in PD patients and was an independent predictor of all-cause mortality and CV mortality. The femoral artery calcification also can predict the mortality, but the calcification of iliac artery, radial artery, and finger arteries cannot predict the mortality of PD patients.

Triglyceride to high-density lipoprotein cholesterol ratio is associated with increased mortality in older patients on peritoneal dialysis

BackgroundThe triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio (TG/HDL-C) has been suggested as a simple method to identify unfavorable cardiovascular (CV) outcomes in the general population. The aim of this study was to investigate the association between the TG/HDL-C ratio and all-cause and CV mortality in peritoneal dialysis (PD) patients.MethodsWe retrospectively analyzed patients on PD from November 1, 2005, to February 28, 2017, with a follow-up period lasting until May 31, 2017. The main outcomes were all-cause and CV mortality.ResultsAmong the 973 PD patients, the mean age was 49.67 ± 14.58 (y). During a median follow-up period of 27.2 months (IQR = 13.4–41.5 months), 229 (23.5%) patients died, with 120 (12.3%) dying as a result of CV diseases. The median serum TG/HDL-C ratio was 1.11 (IQR = 0.71–1.80). In a multivariate Cox regression analysis, patients with higher TG/HDL-C ratio levels (tertile 3) had a higher incidence of CV mortality (adjusted HR = 2.12; 95% CI: 1.21–3.72; P = 0.009) and all-cause mortality (adjusted HR = 2.08; 95% CI: 1.37–3.14; P = 0.001) compared to patients in tertile 1. These associations persisted after excluding the patients who have already taken lipid-lowering medications. For older patients (> 60 years), each 1-unit higher baseline TG/HDL-C level was associated with a 48% (95% CI: 1.06–2.07; P = 0.021) increased risk of all-cause mortality and a 59% (95% CI: 1.03–2.45; P = 0.038) increased risk of CV mortality; however, this association was not observed in patients ≤60 years of age.ConclusionsA higher serum TG/HDL-C ratio was an independent predictor of all-cause and CV mortality in PD patients. Furthermore, an elevated TG/HDL-C ratio was significantly associated with higher all-cause and CV mortality in older PD patients.

Sodium removal in peritoneal dialysis: is there room for a new parameter in dialysis adequacy?

In peritoneal dialysis (PD) (as well as in hemodialysis) small solute clearance measured as Kt/v urea has long been used as a surrogate of dialysis adequacy. A better urea clearance was initially thought to increase survival in dialysis patients (as shown in the CANUSA trial)(1), but reanalysis of the data showed a superior contribution of residual renal function as a predictor of patient survival. Two randomized controlled trials (RCT)(2, 3) supported this observation, demonstrating no survival benefit in patients with higher achieved Kt/v. Then guidelines were revised and a minimum Kt/v of 1,7/week was recommended but little emphasis was given to additional parameters of dialysis adequacy. As such, volume overload and sodium removal have gained major attention, since their optimization has been associated with decreased mortality in PD patients(4, 5). Inadequate sodium removal is associated with fluid overload which leads to ventricular hypertrophy and increased cardiovascular mortality(6). Individualized prescription is key for optimal sodium removal as there are differences between PD techniques (CAPD versus APD) and new strategies for sodium removal have emerged (low sodium solutions and adapted PD). In conclusion, future guidelines should address parameters associated with increased survival outcomes (sodium removal playing an important role) and abandon the current one fit all prescription model.

Risk factors of mortality in peritoneal dialysis patients

Objective To explore the risk factors affecting the death of peritoneal dialysis patients. Methods The clinical data of 275 patients with peritoneal dialysis who place a peritoneal catheter in the Department of Nephrology, First Affiliated Hospital of Guangxi Medical University and had regular peritoneal dialysis for more than 3 months from January 1, 2005 to December 31, 2015 were retrospectively analyzed.Sixty patients died in the observation group, and 215 patients who continued regular peritoneal dialysis were in the control group.Univariate analysis and two-class logistic regression analysis were used to analyze risk factors for death. Results The composition ratio of the primary disease to diabetic nephropathy in the death group and the control group was 15.0% (9/60) and 5.6% (12/215), respectively, the average age of patients entering peritoneal dialysis was (50.6±14.3) years old and (45.7±13.2) years old, respectively(t=-2.518), glomerular filtration rates were 6.0(4.5, 9.4) and 5.1(4.2, 6.6), respectively, blood potassium is (4.2±0.7) mmol/L and (4.5±0.7) mmol/L, respectively, serum creatinine was 721.0 (585.0, 891.3) μmol/L and 847 (723.3, 1 033.3) μmol/L, respectively, there were significant differences between the two groups (t=2.14, all P<0.05). Logistic regression analysis indicated that the primary disease was diabetic nephropathy, and the age of admission to peritoneal dialysis, glomerular filtration rate, blood uric acid are risk factors for death in peritoneal dialysis patients. Conclusion Diabetic nephropathy, age, glomerular filtration rate, and blood uric acid level are independent risk factors for death in peritoneal dialysis patients. Key words: Peritoneal dialysis; Glomerular filtration rate; Risk factors