P1166DOES PERITONEAL PROTEIN LOSS AFFECT CARDIOVASCULAR MORTALITY OF PERITONEAL DIALYSIS PATIENTS ?

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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MO686THE EFFECT OF A CONTINUOUS TRAINING PROGRAM ON PERITONEAL DIALYSIS PATIENTS' SURVIVAL

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab101.008 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Marios Theodoridis ◽

Stamatia Bezirgianidou ◽

Humeyra Serif-Damadoglou ◽

Konstantia Kantartzi ◽

Ploumis Passadakis ◽

...

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Training Program ◽

Cox Regression ◽

Dialysis Patients ◽

Continuous Training ◽

Exit Site Infection ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Group B

Abstract Background and Aims Peritoneal Dialysis (PD) is a well-established method for dialysis of end stage kidney disease patients. Peritoneal membrane alters with time from several causes such as bioincompatible PD solutions, uremia, and the cumulative effect of peritonitis episodes. Each center follows a specific training program to prevent the appearance of peritonitis episodes. The aim of this study was to retrospectively evaluate the influence of proper and continuous training on the mortality of peritoneal dialysis patients. Method This is a single center retrospective study of 133 PD patients conducted for the time period 2009 – 2019 (10 years). The training course was taught one-on-one, nurse-to-patient at the initiation of dialysis and then once every 6 months at their regular visit or sooner if there was a peritonitis episode. The program included a rated questioner based on the Canadian Association of Nephrology Nurses for Nursing Standards and Practice Recommendations published on August 2008. The patients were divided into two groups according to the mean value (34) of their questioner sum (QS). Group A included 69 patients with mean age of 66 ± 15 years (36 M, 33 F) with mean PD duration of 45 ± 30 months and they achieved a score less than 34. Group B included 64 patients with mean age of 61 ± 18 years (42 M, 22 F) with mean PD duration of 62± 32 months and they achieved a score greater than 34. The cumulative all-cause survival of the PD patients was calculated by Kaplan Meier, was compared using Long Rang analysis and was also adjusted for their age, gender, the modality of PD applied, the presence of Diabetes and their level of education. Using Cox Regression, we tried to find independent risk factors such as the score they achieved in the questioner. The two groups were compared also for their overhydration and their frequency appearance of peritonitis or exit site infection. Results The cumulative survival using Kaplan-Meier analysis revealed statistically significant deference between the two groups (Log Rank p<0.001) with Group B (QS>34) achieving better survival. When the survival was adjusted for age, sex, Diabetes, PD modality the result remains the same. Trying to find among the total of our patients the possible risk factors for mortality, using Cox Regression analysis, their QS score (representing their training level for PD) was statistically significant (HR 0,931 {0.892, 0.971}, p=0.001) independent risk factor, as well as age and PD modality, for our patient survival. Additionally, Group B (QS>34) had statistically significant a smaller number of peritonitis episodes (p<0.001) and presence of peripheral edema (p<0.001). Conclusion In our study we concluded that continuous and monitored training of peritoneal dialysis patients has a significant effect on their survival and the frequency of peritonitis appearance.

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The Impact of Timing of Dialysis Initiation on Mortality in Patients with Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.3747/pdi.2013.00328 ◽

2015 ◽

Vol 35 (7) ◽

pp. 703-711 ◽

Cited By ~ 6

Author(s):

Hyung Wook Kim ◽

Su-Hyun Kim ◽

Young Ok Kim ◽

Dong Chan Jin ◽

Ho Chul Song ◽

...

Keyword(s):

Regression Analysis ◽

Peritoneal Dialysis ◽

Renal Disease ◽

Cox Regression ◽

Dialysis Initiation ◽

Cox Regression Analysis ◽

All Cause Mortality ◽

Group A ◽

Group B ◽

The Impact

BackgroundThe impact of timing of dialysis initiation on mortality is controversial in patients with peritoneal dialysis (PD). In this study, we analyzed the impact of timing of dialysis initiation on mortality in the incident PD population.MethodsIncident patients with PD were selected from the Clinical Research Center (CRC) registry for end-stage renal disease (ESRD), a prospective cohort study on dialysis in Korea. Patients were categorized into 3 groups according to the estimated glomerular filtration rate (eGFR) at the initiation of PD using the Modification of Diet in Renal Disease (MDRD) equation. Group A was defined as eGFR < 5 mL/min/1.73m2, group B as eGFR 5 – 10 mL/min/1.73m2, and group C as eGFR > 10 mL/min/1.73m2. Cox regression analysis was used to calculate the adjusted hazard ratio (HR) of mortality with group B as the reference. The primary outcome was all-cause mortality.ResultsA total of 495 incident PD patients were included. The number of patients in group A was 109, group B was 279, and group C was 107. The median follow-up period was 23 months. Multivariate Cox regression analysis showed that group A had a significantly higher risk of all-cause mortality compared with group B (HR 4.13, 95% confidence interval [CI], 1.55 – 11.03, p = 0.005) after adjustment for age, gender, cause of ESRD, serum albumin level, diabetes mellitus, and cardiovascular disease. There was no significant difference in mortality between group C and group B (HR 1.50, 95% CI, 0.59 – 3.80, p = 0.398) after adjustment for clinical variables.ConclusionAn eGFR < 5 mL/min/1.73m2at the initiation of PD was a significant risk factor for death, while an eGFR >10 mL/min/1.73m2at the initiation of PD was not associated with improved survival compared with an eGFR of 5 – 10 mL/min/1.73m2at the initiation of PD.

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Comparison of 24-hour and Office Pulse Wave Velocity for Prediction of Mortality in Hemodialysis Patients

American Journal of Nephrology ◽

10.1159/000499532 ◽

2019 ◽

Vol 49 (4) ◽

pp. 317-327 ◽

Cited By ~ 10

Author(s):

Julia Matschkal ◽

Christopher C. Mayer ◽

Pantelis A. Sarafidis ◽

Georg Lorenz ◽

Matthias C. Braunisch ◽

...

Keyword(s):

Regression Analysis ◽

Pulse Wave Velocity ◽

Wave Velocity ◽

Cardiovascular Mortality ◽

Pulse Wave ◽

Cox Regression ◽

Hemodialysis Patients ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

All Cause Mortality

Background: Mortality in hemodialysis patients still remains unacceptably high. Enhanced arterial stiffness is a known cardiovascular risk factor, and pulse wave velocity (PWV) has proven to be a valid parameter to quantify risk. Recent studies showed controversial results regarding the prognostic significance of PWV for mortality in hemodialysis patients, which may be due to methodological issues, such as assessment of PWV in the office setting (Office-PWV). Method: This study cohort contains patients from the “Risk stratification in end-stage renal disease – the ISAR study,” a multicenter prospective longitudinal observatory cohort study. We examined and compared the predictive value of ambulatory 24-hour PWV (24 h-PWV) and Office-PWV on mortality in a total of 344 hemodialysis patients. The endpoints of the study were all-cause and cardiovascular mortality. Survival analysis included Kaplan-Meier estimates and Cox regression analysis. Results: During a follow-up of 36 months, a total of 89 patients died, 35 patients due to cardiovascular cause. Kaplan-Meier estimates for tertiles of 24 h-PWV and Office-PWV were similarly associated with mortality. In univariate Cox regression analysis, 24 h-PWV and Office-PWV were equivalent predictors for all-cause and cardiovascular mortality. After adjustment for common risk factors, only 24 h-PWV remained solely predictive for all-cause mortality (hazard ratio 2.51 [95% CI 1.31–4.81]; p = 0.004). Conclusions: Comparing both measurements, 24 h-PWV is an independent predictor for all-cause-mortality in hemodialysis patients beyond Office-PWV.

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Bleeding risk of haemodialysis and peritoneal dialysis patients

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa216 ◽

2020 ◽

Vol 36 (1) ◽

pp. 170-175

Author(s):

Anita van Eck van der Sluijs ◽

Alferso C Abrahams ◽

Maarten B Rookmaaker ◽

Marianne C Verhaar ◽

Willem Jan W Bos ◽

...

Keyword(s):

Regression Analysis ◽

Peritoneal Dialysis ◽

Cox Regression ◽

Bleeding Risk ◽

Time Dependent ◽

Antiplatelet Drug ◽

Dialysis Modality ◽

Limited Information ◽

Dialysis Patients ◽

Cox Regression Analysis

Abstract Background Dialysis patients have an increased bleeding risk as compared with the general population. However, there is limited information whether bleeding risks are different for patients treated with haemodialysis (HD) or peritoneal dialysis (PD). From a clinical point of view, this information could influence therapy choice. Therefore the aim of this study was to investigate the association between dialysis modality and bleeding risk. Methods Incident dialysis patients from the Netherlands Cooperative Study on the Adequacy of Dialysis were prospectively followed for major bleeding events over 3 years. Hazard ratios with 95% confidence intervals (CIs) were calculated for HD compared with PD using a time-dependent Cox regression analysis, with updates on dialysis modality. Results In total, 1745 patients started dialysis, of whom 1211 (69.4%) received HD and 534 (30.6%) PD. The bleeding rate was 60.8/1000 person-years for HD patients and 34.6/1000 person-years for PD patients. The time-dependent Cox regression analysis showed that after adjustment for age, sex, primary kidney disease, prior bleeding, cardiovascular disease, antiplatelet drug use, vitamin K antagonist use, erythropoietin use, arterial hypertension, residual glomerular filtratin rate, haemoglobin and albumin levels, bleeding risk for HD patients compared with PD increased 1.5-fold (95% CI 1.0–2.2). Conclusions In this large prospective cohort of incident dialysis patients, HD patients had an increased bleeding risk compared with PD patients. In particular, HD patients with a history of prior bleeding had an increased bleeding risk.

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Aortic-Brachial Stiffness Mismatch and Mortality in Peritoneal Dialysis Patients

Kidney & Blood Pressure Research ◽

10.1159/000498876 ◽

2019 ◽

Vol 44 (1) ◽

pp. 123-132 ◽

Cited By ~ 1

Author(s):

WenHan Bao ◽

FangYu Wang ◽

Wen Tang

Keyword(s):

Regression Analysis ◽

Peritoneal Dialysis ◽

Arterial Stiffness ◽

Pulse Wave Velocity ◽

Wave Velocity ◽

Pulse Wave ◽

Cox Regression ◽

Dialysis Patients ◽

Cox Regression Analysis ◽

Cvd Mortality

Background/Aims: Possible predictive value of aortic-brachial arterial stiffness mismatch assessed by pulse wave velocity PWV ratio in peritoneal dialysis patients’ outcomes need to be further elucidated. The aim of this study is to investigate the predictor value of PWV ratio on peritoneal dialysis (PD) patients’ outcomes in China. Methods: In this longitudinal cohort study, patients who started PD during September 20, 2005, to February 05, 2008, were included. All the patients were followed until January 31, 2018. Aortic-brachial arterial stiffness mismatch was assessed using carotid-femoral pulse wave velocity divided by carotid-radial pulse wave velocity (PWV ratio). Results: A total of 181 incident PD patients were included. The median survival of patients in PWV ratio above median group (4.03 years, 95% CI 4.64-7.99 years) was shorter than that of PWV ratio below median group (10.43 years, 95% CI 9.74-11.12 years, p< 0.001). The cardiovascular mortality rate in PWV ratio above median group were significantly higher than that of PWV below median group (log rank test, p< 0.001). Univariate Cox regression analysis showed that both PWV ratio (HR 2.42, 95% CI 1.80-3.25, p< 0.001) and CF-PWV (HR 1.27, 95% CI 1.16-1.38, p< 0.001) were associated with high patients’ all-cause mortality. Multivariable Cox regression analysis showed that the PWV ratio was a strong and significantly predictor of cardiovascular mortality (HR 2.08 95% CI 1.16-3.71, p=0.014) after adjusting for coronary heart disease history (HR 2.39, 95% CI 1.20-4.76, p=0.013), diabetes mellitus history (HR 2.84, 95% CI 1.51-5.33, p=0.001). However, the CF-PWV was failed to be included as a significant predictor for both all-cause and CVD mortality in the multivariable Cox regression model. Conclusion: Aortic-brachial arterial stiffness mismatch as assessed by PWV ratio, a new arteries stiffness risk parameter, is a significant prognostic indicator of CVD mortality in PD patients. We demonstrated that the discriminative power of the PWV ratio for both all-cause and CVD mortality was better than that CF-PWV.

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Elevated TG/HDL-C and Non-HDL-C/HDL-C Ratios Predict Mortality in Peritoneal Dialysis Patients

10.21203/rs.3.rs-21087/v1 ◽

2020 ◽

Author(s):

Wenkai Xia ◽

Xiajuan Yao ◽

Yan Chen ◽

Jie Lin ◽

Volker Vielhauer ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Cox Regression ◽

Predictive Accuracy ◽

Serum Triglyceride ◽

Hdl Cholesterol ◽

Atherogenic Dyslipidemia ◽

Dialysis Patients ◽

Cox Regression Analysis ◽

Kaplan Meier

Abstract Background and Aims: Dyslipidemia 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. Here, we investigated the prognostic value of the serum triglyceride/HDL cholesterol (TG/HDL-C) ratio and non-HDL-C/HDL-C ratio in peritoneal dialysis patients to predict all-cause mortality. Methods 214 PD 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 OS 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). Results The optimal cut-off values for TG/HDL-C ratio and non-HDL-C/HDL-C ratio 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 OS in PD patients. Multivariate analysis demonstrated that elevated TG/HDL-C ratio as well as non-HDL/HDL-C ratios were independent markers to predict reduced OS. The TG/HDL-C ratio (HR 2.60, 95% CI 1.40–4.83, P = 0.002) was superior to non-HDL-C/HDL-C ratio based on hazard ratio (HR 2.43, 95% CI 1.09–5.40, P = 0.029). Conclusion TG/HDL-C ratio and non-HDL-C/HDL-C were identified as potential prognostic biomarkers in PD patients. The proposed nomograms can be utilized for prediction of OS in PD patients.

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Mortality and associated risk factors of COVID-19 infection in dialysis patients in Qatar: A nationwide cohort study

PLoS ONE ◽

10.1371/journal.pone.0254246 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254246

Author(s):

Tarek Abdel Latif Ghonimi ◽

Mohamad Mahmood Alkad ◽

Essa Abdulla Abuhelaiqa ◽

Muftah M. Othman ◽

Musab Ahmed Elgaali ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Regression Analysis ◽

Peritoneal Dialysis ◽

Cox Regression ◽

The State ◽

Dialysis Patients ◽

Cox Regression Analysis ◽

Factors Associated ◽

Icu Admission

Context Patients on maintenance dialysis are more susceptible to COVID-19 and its severe form. We studied the mortality and associated risks of COVID-19 infection in dialysis patients in the state of Qatar. Methods This was an observational, analytical, retrospective, nationwide study. We included all adult patients on maintenance dialysis therapy who tested positive for COVID-19 (PCR assay of the nasopharyngeal swab) during the period from February 1, 2020, to July 19, 2020. Our primary outcome was to study the mortality of COVID-19 in dialysis patients in Qatar and risk factors associated with it. Our secondary objectives were to study incidence and severity of COVID-19 in dialysis patients and comparing outcomes between hemodialysis and peritoneal dialysis patients. Patient demographics and clinical features were collected from a national electronic medical record. Univariate Cox regression analysis was performed to evaluate potential risk factors for mortality in our cohort. Results 76 out of 1064 dialysis patients were diagnosed with COVID-19 (age 56±13.6, 56 hemodialysis and 20 peritoneal dialysis, 56 males). During the study period, 7.1% of all dialysis patients contracted COVID-19. Male dialysis patients had double the incidence of COVID-19 than females (9% versus 4.5% respectively; p<0.01). The most common symptoms on presentation were fever (57.9%), cough (56.6%), and shortness of breath (25%). Pneumonia was diagnosed in 72% of dialysis patients with COVID-19. High severity manifested as 25% of patients requiring admission to the intensive care unit, 18.4% had ARDS, 17.1% required mechanical ventilation, and 14.5% required inotropes. The mean length of hospital stay was 19.2 ± -12 days. Mortality due to COVID-19 among our dialysis cohort was 15%. Univariate Cox regression analysis for risk factors associated with COVID-19-related death in dialysis patients showed significant increases in risks with age (OR 1.077, CI 95%(1.018–1.139), p = 0.01), CHF and COPD (both same OR 8.974, CI 95% (1.039–77.5), p = 0.046), history of DVT (OR 5.762, CI 95% (1.227–27.057), p = 0.026), Atrial fibrillation (OR 7.285, CI 95%(2.029–26.150), p = 0.002), hypoxia (OR: 16.6; CI 95%(3.574–77.715), p = <0.001), ICU admission (HR30.8, CI 95% (3.9–241.2), p = 0.001), Mechanical ventilation (HR 50.07 CI 95% (6.4–391.2)), p<0.001) and using inotropes(HR 19.17, CI 95% (11.57–718.5), p<0.001). In a multivariate analysis, only ICU admission was found to be significantly associated with death [OR = 32.8 (3.5–305.4), p = 0.002)]. Conclusion This is the first study to be conducted at a national level in Qatar exploring COVID-19 in a dialysis population. Dialysis patients had a high incidence of COVID-19 infection and related mortality compared to previous reports of the general population in the state of Qatar (7.1% versus 4% and 15% versus 0.15% respectively). We also observed a strong association between death related to COVID-19 infection in dialysis patients and admission to ICU.

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Identification and Analysis of Three Hub Prognostic Genes Related to Osteosarcoma Metastasis

Journal of Oncology ◽

10.1155/2021/6646459 ◽

2021 ◽

Vol 2021 ◽

pp. 1-16

Author(s):

Jianye Tan ◽

Haofeng Liang ◽

Bingsheng Yang ◽

Shuang Zhu ◽

Guofeng Wu ◽

...

Keyword(s):

Regression Analysis ◽

Cox Regression ◽

Survival Rates ◽

Prognostic Biomarkers ◽

Messenger Rnas ◽

Hub Genes ◽

Cox Regression Analysis ◽

Expression Levels ◽

Kaplan Meier ◽

Before And After

Osteosarcoma (OS) often occurs in children and often undergoes metastasis, resulting in lower survival rates. Information on the complexity and pathogenic mechanism of OS is limited, and thus, the development of treatments involving alternative molecular and genetic targets is hampered. We categorized transcriptome data into metastasis and nonmetastasis groups, and 400 differential RNAs (230 messenger RNAs (mRNAs) and 170 long noncoding RNAs (lncRNAs)) were obtained by the edgeR package. Prognostic genes were identified by performing univariate Cox regression analysis and the Kaplan–Meier (KM) survival analysis. We then examined the correlation between the expression level of prognostic lncRNAs and mRNAs. Furthermore, microRNAs (miRNAs) corresponding to the coexpression of lncRNA-mRNA was predicted, which was used to construct a competitive endogenous RNA (ceRNA) regulatory network. Finally, multivariate Cox proportional risk regression analysis was used to identify hub prognostic genes. Three hub prognostic genes (ABCG8, LOXL4, and PDE1B) were identified as potential prognostic biomarkers and therapeutic targets for OS. Furthermore, transcriptions factors (TFs) (DBP, ESX1, FOS, FOXI1, MEF2C, NFE2, and OTX2) and lncRNAs (RP11-357H14.16, RP11-284N8.3, and RP11-629G13.1) that were able to affect the expression levels of genes before and after transcription were found to regulate the prognostic hub genes. In addition, we identified drugs related to the prognostic hub genes, which may have potential clinical applications. Immunohistochemistry (IHC) and quantitative real-time polymerase chain reaction (qRT-PCR) confirmed that the expression levels of ABCG8, LOXL4, and PDE1B coincided with the results of bioinformatics analysis. Moreover, the relationship between the hub prognostic gene expression and patient prognosis was also validated. Our study elucidated the roles of three novel prognostic biomarkers in the pathogenesis of OS as well as presenting a potential clinical treatment for OS.

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Predictive Value of Atrial Electromechanical Delay on Long-Term Cardiovascular Outcomes in Hemodialysis Patients

American Journal of Nephrology ◽

10.1159/000441099 ◽

2015 ◽

Vol 42 (3) ◽

pp. 239-249 ◽

Cited By ~ 2

Author(s):

Kultigin Turkmen ◽

Levent Demirtas ◽

Ergun Topal ◽

Abduzhappar Gaipov ◽

Ismail Kocyigit ◽

...

Keyword(s):

Regression Analysis ◽

Total Cholesterol ◽

Cox Regression ◽

Healthy Individuals ◽

Electromechanical Delay ◽

Cox Regression Analysis ◽

Atrial Electromechanical Delay ◽

Kaplan Meier ◽

All Cause Mortality ◽

Spearman Test

Background: Atrial electromechanical delay (AEMD) times were considered independent predictors of cardiovascular morbidity among the general population. We aimed at evaluating AEMD times and other risk factors associated with 2-year combined cardiovascular (CV) events in HD patients. Material and Methods: Sixty hemodialysis (HD) and 44 healthy individuals were enrolled in this prospective study. Echocardiography was performed before the mid-week dialysis session for HD patients. Data were expressed as mean ± SD. Spearman test was used to assess linear associations. Survival was examined with the Kaplan-Meier method. Multivariate Cox regression analysis was used to determine the predictors of combined CV events in this cohort. Results: At the beginning of the study, left intra-atrial-AEMD times were significantly longer in HD patients compared to the left intra-atrial-AEMD times in healthy individuals. After 24 months, 41 patients were still on HD treatment and 19 (31.6%) had died. Serum triglyceride, total cholesterol and albumin were found to be higher and C-reactive protein (CRP) levels, left intra-atrial EMD time (LIAT) and interatrial EMD times were found to be lower in survived HD patients. With the cut-off median values of 3.5 g/dl for albumin, 0.87 mg/dl for CRP, 157 mg/dl for total cholesterol and 151 mg/dl for triglyceride, the Kaplan-Meier curves demonstrated significant differences in terms of all-cause mortality. We also demonstrated the Kaplan-Meier survival curves of HD patients according to tertile values of LIAT. Cox regression analysis revealed that increased CRP and higher LIAT were found to be independent predictors of combined CV events. Conclusions: Increased LIAT and inflammation were found to be closely associated with 2 years combined CV events and all-cause mortality in HD patients.

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Variability of Peritoneal Protein Loss in Diabetic and Nondiabetic Patients on Continuous Ambulatory Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686089301302s60 ◽

1993 ◽

Vol 13 (2_suppl) ◽

pp. 242-244 ◽

Cited By ~ 7

Author(s):

Sophia Spaia ◽

Fotini Christidou ◽

Panayotis Pangidis ◽

Thomas Tsoulkas ◽

Michalis Pazarloglou ◽

...

Keyword(s):

Body Weight ◽

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Total Protein ◽

Peritoneal Fluid ◽

Protein Loss ◽

Glucose Levels ◽

Short Period ◽

Group A ◽

Group B

In order to evaluate the Influence of diabetes mellitus on peritoneal membrane permeability, we studied the peritoneal protein loss In two groups of patients. Group A consisted of 16 patients (9 nondlabetics and 7 diabetics) who were In the first month of treatment on continuous ambulatory peritoneal dialysis (CAPO). Group B consisted of 13 patients (7 nondlabetics and 6 diabetics) who had been on CAPO for approximately 15 months. In both groups we measured the body weight, serum total protein, albumin, and total protein, urea, and glucose In the peritoneal fluid. We did not find any difference In groups A and B between diabetics and nondlabetics as far as the estimated parameters were concerned. Age, body weight, serum biochemistry, and protein and urea content In peritoneal fluid were similar, when group A was compared to group B. Patients of group B hed on average higher protein losses than those who had been on the method for a short period (mean 7.9 g/dL, vs 6.09 g/dL). Six patients were followed for over 15 months and were found to have significantly Increased protein losses (p=0.02). Glucose levels In peritoneal fluid were significantly lower In patients In group B, p<0.05 (mean 51.8 g/dL vs 37.1 g/dL). Peritoneal protein loss does not seem to differ between diabetic and nondiabetic patients with end-stage renal disease treated with CAPO, at any given time of the treatment. We observed an Increase In protein loss In some patients and a tendency to Increase the protein loss In others. This, along with the fall In glucose levels, might reflect progressive alterations In structure and permeability of the elements Involved In peritoneal transport, and It should receive further evaluation.

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