Nomogram for Predicting Cardiovascular Mortality in Incident Peritoneal Dialysis Patients: An Observational Study

Abstract Background and Aims Peritoneal protein loss (PPL) through peritoneal effluent has been a well-recognized detrimental result of peritoneal dialysis (PD). The amount of protein lost will depend on dialysis time, protein size, its serum concentration and other factors including patients’ clinical status. Peritoneal protein loss may be a manifestation of endothelial dysfunction, as with another type of capillary protein leakage, microalbuminuria, a recognized endothelial dysfunction marker. The aim of this study was to retrospectively evaluate the influence of PPL on cardiovascular mortality of peritoneal dialysis patients Method This is a single center retrospective study of 84 PD patients (m=54, f=30) with mean age of 65.2±17 years, mean PD duration of 43.2±24.9 months conducted for the time period from 2006 to 2019 (13 years). The patients were divided into two groups according to the amount of protein excreted during the modified Peritoneal Equilibration Test (PET) procedure using PD solution of 3.86% DW, 2 Lt infusion volume for total time of 4 hours. The total amount of proteins excreted was calculate from PET by multiplying the concentration of proteins at the end of the test with the total volume of PD fluid at the same time. Group A excreted a total amount of proteins < 1.55 gr (median value) at the end of PET test and Group B > 1.55 gr. The cumulative all-cause and cardiovascular survival of the PD patients was calculated by Kaplan Meier while the possible effect of any parameter in survival rates was evaluated by using Cox Regression analysis Results There was not any statistically significant difference between the two groups according to PD duration, age, dialysis adequacy targets, Residual Renal Function(RRF), BMI, ultrafiltration volume during PET and their transport status. The cumulative all-cause survival using Kaplan-Meier analysis revealed no statistically significant deference between the two groups (Log Rank p=0.55) even though mortality risk was adjusted for several factors (Cox Regression). When cardiovascular survival, using Cox Regression analysis, was adjusted for age, sex, Diabetes, PD modality, dialysis Kt/V and RRF we found that Group A (with protein excretion < 1.55 gr) had statistically significant better cardiovascular survival (p=0.029) compared to Group B. We confirm these results while trying to find among the total of our patients the possible risk factors for cardiovascular mortality. Using Cox Regression analysis, the amount of protein excreted during PET procedure and the type of PD solutions (high or low in GDPs) used were statistically significant (p=0.019 and p=0.04 respectively) independent risk factors for cardiovascular survival in our patients. Conclusion These results indicate that protein loss during peritoneal dialysis procedure has negative impact on cardiovascular mortality and survival of PD patients. Additionally, the use of PD solutions with low Glucose Degradation Products (GDPs) and AGEs may improve PD patient’s cardiovascular survival. Randomized interventional studies are encouraged to address the pathological concern of PPL in the future, namely its effects on cardiovascular conditions or its role as marker and effort to reduce PPL using ACE inhibitors or vit D should be considered only if it diminishes cardiovascular morbidity or mortality.

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Characteristics and prognostic outcome factors in elderly peritoneal dialysis patients:a prospective observational study

10.21203/rs.3.rs-41395/v2 ◽

2020 ◽

Author(s):

Xiaoying Ma ◽

HaiPing Xu ◽

FuYun Sun

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Diabetic Nephropathy ◽

Heart Disease ◽

Peritoneal Dialysis ◽

Observational Study ◽

Elderly Patients ◽

Prospective Observational Study ◽

Elderly Group ◽

Dialysis Patients

Abstract Background: This study aimed to analyze the characteristics, outcomes and prognosis factors of survival in elderly peritoneal dialysis patients, so as to better understand the status of elderly peritoneal dialysis patients and improve their quality of life.Methods: This study was a prospective, observational study that included peritoneal dialysis (PD)patients.Categorizing by age, elderly group aged ≥ 65, younger group aged < 65. Clinical characteristics, survival and transferring to hemodialysis were compared between two groups.Meanwhile, risk factors for death in elderly PD patients were explored.Results: A total of 202 PD patients were enrolled, including 61 in elderly group and 141 in younger group. Among elderly individuals,serum albumin and normalized protein catabolic rate(nPCR) decreased, the incidence of previous cardiovascular, cerebrovascular diseases and Charlson Comorbidity Index(CCI) were higher.The major primary disease in elderly patients was diabetic nephropathy, significant differences were found between elderly and younger group(P < 0.01). The mortality in elderly group was substantially higher, 27 patients (44.3%) died in elderly group and 21 patients(14.3%) died in younger group .The 1-year,2-year,3-year,4-year survival rate were 81.97%, 70.49%, 60.66%, 55.74% respectively. Cardiovascular disease was the main cause of death in elderly PD patients. Higher BMI, CCI, and previous ischemic heart disease were risk factors for long-term survival of elderly PD patients. Compared with the younger group, elderly patients were less likely to transfer to hemodialysis: 2 cases (3.3%) in elderly group and 23 cases (16.3%) in younger group. Peritonitis was the primary reason for converting to hemodialysis(HD) in both two groups.Conclusions: Poor nutrition, more complications and diabetic nephropathy were characteristics of elderly PD patients. High BMI, CCI and previous ischemic heart disease were independent predictors of death in elderly PD patients. Cardiovascular disease was the main cause of death in elderly PD patients，while the chief reason of transferring to hemodialysis was peritonitis.

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Characteristics and prognostic outcome factors in elderly peritoneal dialysis patients:a prospective observational study

10.21203/rs.3.rs-41395/v1 ◽

2020 ◽

Author(s):

Xiaoying Ma ◽

HaiPing Xu ◽

FuYun Sun

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Diabetic Nephropathy ◽

Peritoneal Dialysis ◽

Observational Study ◽

Elderly Patients ◽

Cause Of Death ◽

Prospective Observational Study ◽

Elderly Group ◽

Dialysis Patients

Abstract Background This study aimed to analyze the characteristics, outcomes and prognosis factors of survival in elderly peritoneal dialysis patients, so as to better understand the status of elderly peritoneal dialysis patients and improve their quality of life.Methods This study was a prospective, observational study that included peritoneal dialysis (PD)patients.Categorizing by age, elderly group is aged ≥ 65, younger group is aged < 65. Clinical characteristics, survival and transferring to hemodialysis were compared between two groups.Meanwhile, risk factors of death in elderly PD patients were explored.Results A total of 202 PD patients were enrolled, including 61 in elderly group and 141 in younger group. The comparison of baseline data between two groups: in elderly group serum albumin and normalized protein catabolic rate(nPCR) decreased, the incidence of previous cardiovascular and cerebrovascular diseases and Charlson Comorbidity Index(CCI) were higher, the major primary disease in elderly patients was diabetic nephropathy, significant differences were found between elderly and younger group(P < 0.01). The mortality in elderly group was substantially higher, 27 patients (44.3%) died in elderly group and 21 patients(14.3%) died in younger group .The 1-year,2-year,3-year,4-year survival rate were 81.97%, 70.49%, 60.66%, 55.74%,respectively. Cardiovascular disease was the main cause of death in elderly PD patients. Higher BMI 、CCI, and previous ischemic heart disease(IHD)were risk factors for long-term survival of elderly PD patients. Compared with the younger group, elderly patients were less likely to transfer to hemodialysis: 2 cases (3.3%) in elderly group and 23 cases (16.3%) in younger group. Peritonitis was primary reason for converting to hemodialysis(HD) in both two group.Conclusions Poor nutrition, more complications and diabetic nephropathy were characteristics of elderly PD patients. High BMI, CCI and previous IHD were independent predictors of death in elderly PD patients. Cardiovascular disease was the main cause of death in elderly PD patients,while the chief reason of transferring to hemodialysis was peritonitis.

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