MO702DIFFERENCES IN HOSPITALISATION BETWEEN PERITONEAL DIALYSIS AND IN-CENTRE HAEMODIALYSIS PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Anita Van Eck van der Sluijs ◽  
Anna Bonenkamp ◽  
Vera Van Wallene ◽  
Tiny Hoekstra ◽  
Birgit Lissenberg ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Peritoneal Dialysis ◽  
Length Of Stay ◽  
Cox Regression ◽  
Hospitalisation Rate ◽  
First Year ◽  
Dialysis Modality ◽  
Dialysis Treatment ◽  
Common Cause ◽  
Cox Regression Analysis

Abstract Background and Aims End stage kidney disease (ESKD) and dialysis treatment are associated with high morbidity, frequently resulting in hospitalisation. However, studies comparing hospitalisation between different dialysis modalities report conflicting results. Some studies report an equal number and length of hospital admissions, while others conclude that peritoneal dialysis (PD) patients are more likely to be hospitalised. In addition, most studies only analyse data of patients that remain on their initial dialysis modality. However, a transition from one dialysis modality to another, e.g. from PD to in-centre haemodialysis (ICHD), certainly occurs in current dialysis practice. Therefore, the aim of this study was to compare hospitalisations between PD and ICHD patients, taking into account transfers between dialysis modalities. Method The retrospective Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes (DOMESTICO) collected hospitalisation data of ESKD patients who started dialysis treatment between 2012 and 2017. Eligible patients had a minimum dialysis duration of 3 months. For baseline comparison, groups were defined based on the dialysis modality (i.e. PD or ICHD) 3 months after dialysis initiation. Primary outcome was hospitalisation rate, which was analysed with a multi-state model that attributed each hospitalisation to the dialysis modality the patient was treated with at that the time. Secondary outcomes were time to first hospitalisation, number of hospitalisations and length of hospitalisation. Time to first hospitalisation was analysed with Cox regression analysis, with dialysis modality as a time-varying covariate. Number of hospitalisations was analysed with negative binomial regression, and length of stay with Poisson regression. All analyses were adjusted for potential confounders. Results In total, 252 PD and 443 ICHD patients from 31 Dutch dialysis centres were included. Baseline characteristics of the groups were comparable, apart from a lower dialysis vintage and a slightly lower comorbidity score in the PD group. Patients transferred more often from PD to ICHD (33%), than from ICHD to PD (11%) during a median follow-up period of 22.0 months [IQR 11.1-36.4]. The crude hospitalisation rate for PD was 2.3 (±5.0) and for ICHD 1.4 (±3.2) hospitalisations per patient-year. Using a multistate model, the adjusted hazard ratio (HR) for hospitalisation rate was 1.1 (95%CI 1.02-1.3) for PD compared to ICHD patients. Cox regression analysis showed a significant difference in time to first hospitalisation with an adjusted HR of 1.3 (95%CI 1.1 - 1.6) for PD compared to ICHD patients in the first year after dialysis initiation. After the first year, the time to first hospitalisation had an adjusted HR of 1.9 (95%CI 1.4–2.5) for PD compared to ICHD patients. The number of hospitalisations was significantly higher, while the length of stay was non-significantly higher for PD patients. In PD patients, the most common cause of all hospitalisations was peritonitis (23%). In ICHD patients, the most common cause was access-related (33%). Conclusion PD was associated with a higher hospitalisation rate, a shorter time to first hospitalisation and more hospitalisations compared to ICHD. One explanation might be that the threshold for admission to hospital is lower for PD patients compared to ICHD patients.

scholarly journals Bleeding risk of haemodialysis and peritoneal dialysis patients

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.

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

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Marios Theodoridis ◽  
Stylianos Panagoutsos ◽  
Ioannis Neofytou ◽  
Konstantia Kantartzi ◽  
Efthimia Mourvati ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Peritoneal Dialysis ◽  
Cardiovascular Mortality ◽  
Cox Regression ◽  
Dialysis Patients ◽  
Protein Loss ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Group A ◽  
Group B

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.

scholarly journals Effects of parathyroid hormone and vitamin D supplementation on stroke among patients receiving peritoneal dialysis

2020 ◽  
Author(s):  
Xiaohan You ◽  
Ying Zhou ◽  
Jianna Zhang ◽  
Qiongxiu Zhou ◽  
Yanling Shi ◽  
...  
Keyword(s):  
Vitamin D ◽  
Regression Analysis ◽  
Peritoneal Dialysis ◽  
Parathyroid Hormone ◽  
Cox Regression ◽  
Vitamin D Supplementation ◽  
P Value ◽  
Cox Regression Analysis ◽  
Increased Risk

Abstract Background : Continuous ambulatory peritoneal dialysis (CAPD) patients have a high incidence of stroke and commonly have increased parathyroid hormone levels and vitamin D insufficiency. We seek to investigate the incidence of stroke and the role of parathyroid hormone and vitamin D supplementation in stroke risk among CAPD patients. Methods: This study employed a retrospective design. We enrolled a Chinese cohort of 980 CAPD patients who were routinely followed in our department. The demographic and clinical data were recorded at the time of initial CAPD and during follow-up. The included patients were separated into non-stroke and stroke groups. The effects of parathyroid hormone and vitamin D supplementation on stroke in CAPD patients was evaluated. The primary endpoint is defined as the first occurrence of stroke, and composite endpoint events are defined as death or switch to hemodialysis during follow-up. Results: A total of 757 eligible CAPD patients with a mean follow-up time of 54.7 (standard deviation, 33) months were included in the study. The median incidence of stroke among our CAPD patients was 18.9 (interquartile range, 15.7 - 22.1) per 1000 person-years. A significant nonlinear correlation between baseline iPTH and hazard of stroke (p-value of linear association = 0.2 and nonlinear association = 0.002) was observed in our univariate Cox regression analysis, and low baseline iPTH levels (≤150 pg/ml) were associated with an increased cumulative hazard of stroke. Multivariate Cox regression analysis indicated a significant interaction effect between age and iPTH after adjusting for other confounders. Vitamin D supplementation during follow-up was a predictive factor for stroke in our cohort. Conclusions: CAPD patients suffered a high risk of stroke, and lower iPTH levels were significantly correlated with an increased risk of stroke. Nevertheless, vitamin D supplementation may reduce the risk of stroke in these patients.

scholarly journals Role of parathyroid hormone and vitamin D supplementation in stroke among patients on peritoneal dialysis

2020 ◽  
Author(s):  
Xiaohan You ◽  
Ying Zhou ◽  
Jianna Zhang ◽  
Qiongxiu Zhou ◽  
Yanling Shi ◽  
...  
Keyword(s):  
Vitamin D ◽  
Regression Analysis ◽  
Peritoneal Dialysis ◽  
Parathyroid Hormone ◽  
Predictive Factor ◽  
Cox Regression ◽  
Vitamin D Supplementation ◽  
Cox Regression Analysis

Abstract Background Continuous ambulatory peritoneal dialysis (CAPD) patients have a high incidence of stroke and commonly have increased parathyroid hormone levels and vitamin D insufficiency. We seek to investigate the incidence of stroke and the role of parathyroid hormone and vitamin D supplementation in stroke risk among CAPD patients.Methods This is a retrospective study enrolled a Chinese cohort of 980 CAPD patients who were routinely followed up in our department. The demographic and clinical data recorded at the time of initial CAPD and during follow-up time are collected. The included cases were separated into nonstroke and stroke groups. The role of parathyroid hormone and vitamin D supplementation for stroke in CAPD patients is evaluated. The primary endpoint is defined as the first-time occurrence of stroke, and composite endpoint events are defined as death or switch to hemodialysis during follow-up.Results A total of 757 eligible CAPD patients with a mean follow-up time of 54.7 (standard deviation (SD) 33) months were included in the study. The median incidence of stroke among our CAPD patients was 18.9 (IQR, 15.7 - 22.1) per 1000 person-years. A significant nonlinear correlation between baseline iPTH and hazard of stroke (p value of linear association = 0.2 and nonlinear association = 0.002) was observed in our univariate Cox regression analysis, and low baseline iPTH levels (≤150 pg/ml) were associated with an increased cumulative hazard of stroke. Multivariate Cox regression analysis indicated a significant interaction effect between age and iPTH after adjusting for other confounders. Vitamin D supplementation during follow-up was a predictive factor for stroke in our cohort.Conclusions CAPD patients suffered a high risk of stroke. Lower iPTH levels were significantly associated with an increased risk of stroke. Vitamin D supplementation is an independent predictive factor for stroke among CAPD patients.

scholarly journals Aortic-Brachial Stiffness Mismatch and Mortality in Peritoneal Dialysis Patients

2019 ◽  
Vol 44 (1) ◽  
pp. 123-132 ◽  
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.

Effect of uric acid levels on mortality in Japanese peritoneal dialysis patients

2020 ◽  
pp. 089686082092947
Author(s):  
Naoki Sugano ◽  
Yukio Maruyama ◽  
Iwao Ohno ◽  
Atsushi Wada ◽  
Takashi Shigematsu ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Uric Acid ◽  
Regression Analysis ◽  
Peritoneal Dialysis ◽  
Cox Regression ◽  
Reference Group ◽  
Continuous Variable ◽  
Cox Regression Analysis ◽  
Covariate Data ◽  
All Cause Mortality

Background: Unlike the situation in the general population, most studies of patients receiving hemodialysis have reported lower uric acid (UA) as associated with higher mortality. However, the relationship between UA level and mortality remains unclear among patients receiving peritoneal dialysis (PD). Methods: We collected baseline data for 4742 prevalent PD patients (age, 63 ± 14 years; male, 61.5%; diabetes, 29.1%; median dialysis duration, 28 months) from a nationwide dialysis registry in Japan at the end of 2012. One-year all-cause and cardiovascular (CV) mortality and mortality caused by infectious disease were assessed using Cox regression analysis and competing-risks regression analysis, respectively. We used multiple imputation to deal with missing covariate data. Results: Within 1 year, 379 patients (8.0%) died, including 129 patients (2.7%) from CV causes and 95 patients (2.0%) from infectious disease. In multivariate analysis, serum UA, treated as a continuous variable, was not associated with any outcome. Conversely, both lower (<297 µmol/L) and higher (≥476 µmol/L) UA levels were independently associated with higher all-cause mortality compared to the reference group (416 to <446 µmol/L) in analyses where serum UA was treated as a categorical variable. Body mass index (BMI) affected the association between serum UA and all-cause mortality (interaction p = 0.049). Conclusions: A U-shaped relationship appears to exist between UA levels and all-cause mortality among Japanese PD patients. Additionally, lower BMI significantly enhanced the effect of UA levels on mortality.

scholarly journals Effects of parathyroid hormone and vitamin D supplementation on stroke among patients receiving peritoneal dialysis

2020 ◽  
Author(s):  
Xiaohan You ◽  
Ying Zhou ◽  
Jianna Zhang ◽  
Qiongxiu Zhou ◽  
Yanling Shi ◽  
...  
Keyword(s):  
Vitamin D ◽  
Regression Analysis ◽  
Peritoneal Dialysis ◽  
Parathyroid Hormone ◽  
Cox Regression ◽  
Vitamin D Supplementation ◽  
P Value ◽  
Cox Regression Analysis ◽  
Increased Risk

Abstract Background: Continuous ambulatory peritoneal dialysis (CAPD) patients have a high incidence of stroke and commonly have increased parathyroid hormone levels and vitamin D insufficiency. We seek to investigate the incidence of stroke and the role of parathyroid hormone and vitamin D supplementation in stroke risk among CAPD patients.Methods: This study employed a retrospective design. We enrolled a Chinese cohort of 980 CAPD patients who were routinely followed in our department. The demographic and clinical data were recorded at the time of initial CAPD and during follow-up. The included patients were separated into non-stroke and stroke groups. The effects of parathyroid hormone and vitamin D supplementation on stroke in CAPD patients was evaluated. The primary endpoint is defined as the first occurrence of stroke, and composite endpoint events are defined as death or switch to hemodialysis during follow-up.Results: A total of 757 eligible CAPD patients with a mean follow-up time of 54.7 (standard deviation, 33) months were included in the study. The median incidence of stroke among our CAPD patients was 18.9 (interquartile range, 15.7 - 22.1) per 1000 person-years. A significant nonlinear correlation between baseline iPTH and hazard of stroke (p-value of linear association = 0.2 and nonlinear association = 0.002) was observed in our univariate Cox regression analysis, and low baseline iPTH levels (≤150 pg/ml) were associated with an increased cumulative hazard of stroke. Multivariate Cox regression analysis indicated a significant interaction effect between age and iPTH after adjusting for other confounders. Vitamin D supplementation during follow-up was a predictive factor for stroke in our cohort.Conclusions: CAPD patients suffered a high risk of stroke, and lower iPTH levels were significantly correlated with an increased risk of stroke. Nevertheless, vitamin D supplementation may reduce the risk of stroke in these patients.

scholarly journals Effects of parathyroid hormone and vitamin D supplementation on stroke among patients receiving peritoneal dialysis

2020 ◽  
Author(s):  
Xiaohan You ◽  
Ying Zhou ◽  
Jianna Zhang ◽  
Qiongxiu Zhou ◽  
Yanling Shi ◽  
...  
Keyword(s):  
Vitamin D ◽  
Regression Analysis ◽  
Peritoneal Dialysis ◽  
Parathyroid Hormone ◽  
Cox Regression ◽  
Vitamin D Supplementation ◽  
P Value ◽  
Cox Regression Analysis ◽  
Increased Risk

Abstract Background: Continuous ambulatory peritoneal dialysis (CAPD) patients have a high incidence of stroke and commonly have increased parathyroid hormone levels and vitamin D insufficiency. We seek to investigate the incidence of stroke and the role of parathyroid hormone and vitamin D supplementation in stroke risk among CAPD patients.Methods: This study employed a retrospective design. We enrolled a Chinese cohort of 980 CAPD patients who were routinely followed in our department. The demographic and clinical data were recorded at the time of initial CAPD and during follow-up. The included patients were separated into non-stroke and stroke groups. The effects of parathyroid hormone and vitamin D supplementation on stroke in CAPD patients was evaluated. The primary endpoint is defined as the first occurrence of stroke, and composite endpoint events are defined as death or switch to hemodialysis during follow-up.Results: A total of 757 eligible CAPD patients with a mean follow-up time of 54.7 (standard deviation, 33) months were included in the study. The median incidence of stroke among our CAPD patients was 18.9 (interquartile range, 15.7 - 22.1) per 1000 person-years. A significant nonlinear correlation between baseline iPTH and hazard of stroke (p-value of linear association = 0.2 and nonlinear association = 0.002) was observed in our univariate Cox regression analysis, and low baseline iPTH levels (≤150 pg/ml) were associated with an increased cumulative hazard of stroke. Multivariate Cox regression analysis indicated a significant interaction effect between age and iPTH after adjusting for other confounders. Vitamin D supplementation during follow-up was a predictive factor for stroke in our cohort. Conclusions: CAPD patients suffered a high risk of stroke, and lower iPTH levels were significantly correlated with an increased risk of stroke. Nevertheless, vitamin D supplementation may reduce the risk of stroke in these patients.

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

PLoS ONE ◽  
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.

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

2015 ◽  
Vol 35 (7) ◽  
pp. 703-711 ◽  
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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