scholarly journals An association between time-varying serum alkaline phosphatase concentrations and mortality rate in patients undergoing peritoneal dialysis: a five-year cohort study

2017 ◽  
Vol 7 (1) ◽  
Author(s):  
Ying Liu ◽  
Jin-Gang Zhu ◽  
Ben-Chung Cheng ◽  
Shang-Chih Liao ◽  
Chih-Hsiung Lee ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Alkaline Phosphatase ◽  
Peritoneal Dialysis ◽  
Serum Alkaline Phosphatase ◽  
Urine Volume ◽  
Time Dependent ◽  
Time Varying ◽  
Cox Models ◽  
Death Risk ◽  
The Relationship

Abstract The relationship between serum alkaline phosphatase (ALP) concentrations and mortality in peritoneal dialysis (PD) patients is rarely reported. We enrolled 667 PD patients in one PD centre in Taiwan to retrospectively examine the association between three ALP concentrations (baseline, time-averaged, time-dependent) and mortality over a 5-year period (2011–2015). Baseline data collection included demographics, clinical, and laboratory parameters. Multivariable-adjusted Cox models were used to analyse the association. Four ALP quartiles were defined at the baseline: ≤62, 63–82, 83–118, and ≥119 U/L. Of 667 patients, 65 patients died, of which 8 patients died due to cardiovascular disease. Females were predominant in the higher ALP quartiles, and 24-h urine volume was significantly proportionately decreased in the higher ALP quartiles. ALP quartiles expressed by the three models were not associated with all-cause or cardiovascular mortalities after adjusting for demographics, liver function, bone metabolism, mortality, hemoglobin, and 24-h urine volume. In conclusion, ALP concentrations were not associated with death risk in PD patients over the 5-year period.

scholarly journals Comparative Mortality–Predictability Using Alkaline Phosphatase and Parathyroid Hormone in Patients on Peritoneal Dialysis and Hemodialysis

2014 ◽  
Vol 34 (7) ◽  
pp. 732-748 ◽  
Author(s):  
Connie M. Rhee ◽  
Miklos Z. Molnar ◽  
Wei Ling Lau ◽  
Vanessa Ravel ◽  
Csaba P. Kovesdy ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Peritoneal Dialysis ◽  
Parathyroid Hormone ◽  
Serum Alkaline Phosphatase ◽  
Reference Ranges ◽  
Cox Models ◽  
Death Risk ◽  
Entry Period ◽  
Hazard Ratios

BackgroundIn hemodialysis (HD) patients, serum alkaline phosphatase (ALP) and parathyroid hormone (PTH) derangements are associated with mortality, but outcome-predictability using ALP and PTH in peritoneal dialysis (PD) patients remains uncertain.MethodsIn a cohort of 9244 adult PD patients from a large national dialysis organization (entry period 2001 – 2006, with follow-up through 2009), we used multivariable Cox models adjusted for case-mix and laboratory covariates to examine the associations of time-averaged ALP and PTH with all-cause mortality. We then compared mortality-predictability using ALP and PTH in 9244 PD and 99 323 HD patients.ResultsIn PD patients, ALP concentrations exceeding 150 U/L were associated with increased mortality (reference ALP: 70 to <90 U/L). Hazard ratios (HRs) and 95% confidence intervals (CIs) were 1.18 (1.03 to 1.36), 1.27 (1.08 to 1.50), 1.49 (1.23 to 1.79), and 1.35 (1.19 to 1.53) for ALP concentrations of 150 to <170 U/L, 170 to <190 U/L, 190 to <210 U/L, and ≥210 U/L respectively. In contrast, we observed a U-shaped association between PTH concentration and death risk in PD patients, with PTH concentrations of less than 200 pg/mL and 700 pg/mL or more associated with increased mortality (reference PTH: 200 to <300 pg/mL). Hazard ratios and 95% CIs were 1.25 (1.12 to 1.41), 1.12 (1.02 to 1.23), 1.06 (0.96 to 1.18), 1.09 (0.97 to 1.24), 1.12 (0.97 to 1.29), 1.18 (0.99 to 1.40), and 1.23 (1.09 to 1.38) for PTH concentrations of <100 pg/mL, 100 to <200 pg/mL, 300 to <400 pg/mL, 400 to <500 pg/mL, 500 to <600 pg/mL, 600 to <700 pg/mL, and ≥700 pg/mL respectively. Compared with PD patients having serum concentrations of ALP and PTH within reference ranges, patients on HD experienced increased mortality across all ALP and PTH concentrations, particularly those in the lowest and highest categories.ConclusionsIn summary, higher ALP concentrations are associated with increased mortality, and lower and higher PTH concentrations are both associated with death risk in PD patients. The utility of ALP in the management of chronic kidney disease mineral bone disorders in PD patients warrants further study.

Time-Dependent Reasons for Peritoneal Dialysis Technique Failure and Mortality

2010 ◽  
Vol 30 (2) ◽  
pp. 170-177 ◽  
Author(s):  
Inna Kolesnyk ◽  
Friedo W. Dekker ◽  
Elisabeth W. Boeschoten ◽  
Raymond T. Krediet
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Peritoneal Dialysis ◽  
The Netherlands ◽  
Patient Survival ◽  
Time Dependent ◽  
First Year ◽  
Technique Survival ◽  
Technique Failure

BackgroundPeritoneal dialysis (PD) technique failure is high compared to hemodialysis (HD). There is a lack of data on the impact of duration of PD treatment on technique survival and on whether there is a difference in risk factors with respect to early and late failure. The aim of this study was to clarify these issues by performing a time-dependent analysis of PD technique and patient survival in a large cohort of incident PD patients.MethodsWe analyzed 709 incident PD patients participating in the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD), who started their treatment between 1997 and 2007. We compared technique and patient survival on PD in 4 periods of follow-up: within the first 3 months, and after 3 – 12 months, 12 – 24 months, and 24 – 36 months of treatment. Cox proportional hazards model was used to analyze survival on PD and technique failure. Risk factors were also identified by comparing patients that were transferred to HD with those that remained on PD. Incidence rates for every cause of dropout for each period of follow-up were calculated to establish their trends with respect to PD treatment duration.ResultsThere was a significant increase in transplantation rate after the first year of treatment. The rate of switching to HD was highest during the first 3 months and decreased afterward. One-, 2- and 3-year technique survival was 87%, 76%, and 66%, respectively. Age, diabetes, and cardiovascular disease appeared to be risk factors for death on PD or switch to HD: a 1-year increase in age was associated with a relative risk (RR) of PD failure of 1.04 [95% confidence interval (CI) 1.003 – 1.06]; for diabetes, RR of stopping PD after 3 months of treatment increased from 1.8 (95% CI 1.1 – 3) during the first year to 2.2 (95% CI 1.3 – 4) after the second year; cardiovascular disease had a major impact in the earliest period (RR 2.5, 95% CI 1.2 – 5) and had a stable influence further on (RR 2, 95% CI 1.1 – 3.5). Loss of 1 mL/minute residual glomerular filtration rate (rGFR) appeared to be a significant predictor of PD failure after 3 months of treatment, but within the first 2 years, RR was 1.1 (95% CI 1.04 – 1.25).ConclusionsIn The Netherlands, transplantation is a main reason to stop PD treatment. The incidence of PD technique failure is at its highest during the earliest months after treatment initiation and decreases later due to fewer catheter and abdominal complications as well as less influence of psychosocial factors. Risk factors for PD discontinuation are those responsible for patient survival: age, cardiovascular disease, diabetes, and rGFR.

Paricalcitol and Peritoneal Protein Loss in Peritoneal Dialysis: A Double-Center Study

2018 ◽  
Vol 46 (2) ◽  
pp. 103-110 ◽  
Author(s):  
Teresa Jerónimo ◽  
Anabela Malho Guedes ◽  
Gloria del Peso ◽  
Ana Paula Silva ◽  
Rafael Selgas ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Multivariate Analysis ◽  
Peritoneal Dialysis ◽  
Pearson Correlation ◽  
Pearson Correlation Coefficient ◽  
Protein Loss ◽  
Student’S T ◽  
The Relationship ◽  
Center Study ◽  
Student’S T Test

Background/Aims: Peritoneal protein loss (PPL) is associated with cardiovascular disease and mortality in peritoneal dialysis (PD). Controversial results have been published about the effect of paricalcitol in PPL among PD patients. This study intends to analyze the relationship between paricalcitol and PPL in PD. Methods: In a retrospective study, prevalent PD patients were divided into 2 groups: “with paricalcitol” and “without paricalcitol”. X2-test, Student’s t test, Pearson correlation coefficient and Logistic Regression analysis were applied. Results: Eighty-two patients were included. PPL was lower among patients medicated with paricalcitol (5.17 ± 1.71 vs. 6.79 ± 2.10 g/24 h, p = 0.0001). In multivariate analysis, paricalcitol and dialysate/plasma ratio of creatinine (D/P creatinine) were independently related to PPL (OR 4.270 [1.437–12.684], p = 0.009 and OR 0.205 [0.064–0.659], p = 0.008, respectively), adjusted for diabetes. Conclusion: Paricalcitol and D/P creatinine were independently related to PPL. Paricalcitol may have an effect on PPL in PD patients

scholarly journals Serum Alkaline Phosphatase Levels Predict Infection-Related Mortality and Hospitalization in Peritoneal Dialysis Patients

PLoS ONE ◽  
2016 ◽  
Vol 11 (6) ◽  
pp. e0157361 ◽  
Author(s):  
Seun Deuk Hwang ◽  
Su-Hyun Kim ◽  
Young Ok Kim ◽  
Dong Chan Jin ◽  
Ho Chul Song ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Peritoneal Dialysis ◽  
Serum Alkaline Phosphatase ◽  
Dialysis Patients ◽  
Related Mortality

scholarly journals Study on reservoir time-varying design flood of inflow based on Poisson process with time-dependent parameters

2018 ◽  
Vol 379 ◽  
pp. 119-123
Author(s):  
Jiqing Li ◽  
Jing Huang ◽  
Jianchang Li
Keyword(s):  
Poisson Process ◽  
Flood Control ◽  
Time Dependent ◽  
Model Parameters ◽  
Time Varying ◽  
Design Flood ◽  
Threshold Method ◽  
Peak Over Threshold ◽  
Peak Over Threshold Method ◽  
The Relationship

Abstract. The time-varying design flood can make full use of the measured data, which can provide the reservoir with the basis of both flood control and operation scheduling. This paper adopts peak over threshold method for flood sampling in unit periods and Poisson process with time-dependent parameters model for simulation of reservoirs time-varying design flood. Considering the relationship between the model parameters and hypothesis, this paper presents the over-threshold intensity, the fitting degree of Poisson distribution and the design flood parameters are the time-varying design flood unit period and threshold discriminant basis, deduced Longyangxia reservoir time-varying design flood process at 9 kinds of design frequencies. The time-varying design flood of inflow is closer to the reservoir actual inflow conditions, which can be used to adjust the operating water level in flood season and make plans for resource utilization of flood in the basin.

scholarly journals Racial and Ethnic Differences in Mortality Associated with Serum Potassium in Incident Peritoneal Dialysis Patients

2019 ◽  
Vol 50 (5) ◽  
pp. 361-369 ◽  
Author(s):  
Rieko Eriguchi ◽  
Yoshitsugu Obi ◽  
Melissa Soohoo ◽  
Connie M. Rhee ◽  
Csaba P. Kovesdy ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Serum Potassium ◽  
Dialysis Patients ◽  
Cox Models ◽  
Baseline Serum ◽  
Racial And Ethnic Differences ◽  
Hispanic Patients ◽  
Race Ethnicity ◽  
The Relationship ◽  
Related Mortality

Background: Abnormalities in serum potassium are risk factors for sudden cardiac death and arrhythmias among dialysis patients. Although a previous study in hemodialysis patients has shown that race/ethnicity may impact the relationship between serum potassium and mortality, the relationship remains unclear among peritoneal dialysis (PD) patients where the dynamics of serum potassium is more stable. Methods: Among 17,664 patients who started PD between January 1, 2007 and December 31, 2011 in a large US dialysis organization, we evaluated the association of serum potassium levels with all-cause and arrhythmia-related deaths across race/ethnicity using time-dependent Cox models with adjustments for demographics. We also used restricted cubic spline functions for serum potassium levels to explore non-linear associations. Results: Baseline serum potassium levels were the highest among Hispanics (4.2 ± 0.7 mEq/L) and lowest among non-Hispanic blacks (4.0 ± 0.7 mEq/L). Among 2,949 deaths during the follow-up of median 2.2 (interquartile ranges 1.3–3.2) years, 683 (23%) were arrhythmia-related deaths. Overall, both hyperkalemia and hypokalemia (i.e., serum potassium levels >5.0 and <3.5 mEq/L, respectively) were associated with higher all-cause and arrhythmia-related mortality. In a stratified analysis according to race/ethnicity, the association of hypokalemia with all-cause and arrhythmia-related mortality was consistent with an attenuation for arrhythmia-related mortality in non-Hispanic blacks. Hyperkalemia was associated with all-cause and arrhythmia-related mortality in non-Hispanic whites and non-Hispanic blacks, but no association was observed in Hispanics. Conclusion: Among incident PD patients, hypokalemia was consistently associated with all-cause and arrhythmia-related deaths irrespective of race/ethnicity. However, while hyperkalemia was associated with both death outcomes in non-Hispanic blacks and whites, it was not associated with either death outcome in Hispanic patients. Further studies are needed to demonstrate whether different strategies should be followed for the management of serum potassium levels according to race/ethnicity.

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