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.

scholarly journals Serum Hepcidin-25 and Risk of Mortality in Patients on Peritoneal Dialysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhong Zhong ◽  
Dan Luo ◽  
Ning Luo ◽  
Bin Li ◽  
Dongying Fu ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Multivariable Analysis ◽  
Hazard Ratio ◽  
Enzyme Linked Immunosorbent Assay ◽  
Baseline Serum ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Serum Hepcidin ◽  
The Relationship ◽  
Related Mortality

Background: Increased serum hepcidin-25 level is associated with excess mortality in hemodialysis patients. However, there is a dearth of published information about its predictive effect for survival in patients on peritoneal dialysis (PD). The purpose of this study is to evaluate the association of serum hepcidin-25 with the risk of mortality in PD patients.Methods: Serum hepcidin-25 level was measured using an enzyme-linked immunosorbent assay in a prospective cohort study of PD patients with stored serum samples at baseline. Multivariate linear regression model was used to determine clinical characteristics associated with serum hepcidin-25 concentration. We evaluated the relationship between serum hepcidin-25 and all-cause mortality using a Cox proportional hazards model and the relationship between hepcidin-25 and cardiovascular (CV) and infection-related deaths using competing-risks regression models.Results: In total, 513 PD patients were included in this study. The median serum hepcidin-25 level was 40.9 (17.9–85.9) ng/mL. Body mass index and serum ferritin were positively correlated with serum hepcidin-25 levels. During a median follow-up period of 64.1 months, 122 (24%) patients died, including 61 (50%) CV deaths and 32 (26%) infection-related deaths. In multivariable analysis, patients with the highest tertile of serum hepcidin-25 had a greater risk of all-cause [adjusted hazard ratio (aHR) 1.85, 95% confidence interval (95%CI), 1.14 to 3.00, P = 0.013] and infection-related mortality (adjusted subdistribution hazard ratio [aSHR], 2.61; 95%CI, 1.01 to 6.76, P = 0.049) when compared with those in the second tertile. However, no significant relationship was observed between serum hepcidin-25 and CV mortality.Conclusions: Higher baseline serum hepcidin-25 level was associated with increased risk for all-cause and infection-related mortality in PD patients.

scholarly journals Racial and Ethnic Differences in Mortality Associated with Serum Potassium in a Large Hemodialysis Cohort

2017 ◽  
Vol 45 (6) ◽  
pp. 509-521 ◽  
Author(s):  
Taehee Kim ◽  
Connie M. Rhee ◽  
Elani Streja ◽  
Melissa Soohoo ◽  
Yoshitsugu Obi ◽  
...  
Keyword(s):  
African American ◽  
Ethnic Differences ◽  
Mortality Risk ◽  
Cardiovascular Mortality ◽  
Serum Potassium ◽  
Maintenance Hemodialysis ◽  
Case Mix ◽  
Baseline Serum ◽  
Racial And Ethnic Differences ◽  
Race Ethnicity

Background: Hyperkalemia is observed in chronic kidney disease patients and may be a risk factor for life-threatening arrhythmias and death. Race/ethnicity may be important modifiers of the potassium-mortality relationship in maintenance hemodialysis (MHD) patients given that potassium intake and excretion vary among minorities. Methods: We examined racial/ethnic differences in baseline serum potassium levels and all-cause and cardiovascular mortality using Cox proportional hazard models and restricted cubic splines in a cohort of 102,241 incident MHD patients. Serum potassium was categorized into 6 groups: ≤3.6, >3.6 to ≤4.0, >4.0 to ≤4.5 (reference), >4.5 to ≤5.0, >5.0 to ≤5.5, and >5.5 mEq/L. Models were adjusted for case-mix and malnutrition-inflammation cachexia syndrome (MICS) covariates. Results: The cohort was composed of 50% whites, 34% African-Americans, and 16% Hispanics. Hispanics tended to have the highest baseline serum potassium levels (mean ± SD: 4.58 ± 0.55 mEq/L). Patients in our cohort were followed for a median of 1.3 years (interquartile range 0.6-2.5). In our cohort, associations between higher potassium (>5.5 mEq/L) and higher mortality risk were observed in African-American and whites, but not Hispanic patients in models adjusted for case-mix and MICS covariates. While in Hispanics only, lower serum potassium (<3.6 mEq/L) levels were associated with higher mortality risk. Similar trends were observed for cardiovascular mortality. Conclusions: Higher potassium levels were associated with higher mortality risk in white and African-American MHD patients, whereas lower potassium levels were associated with higher death risk in Hispanics. Further studies are needed to determine the underlying mechanisms for the differential association between potassium and mortality across race/ethnicity.

Multicentre registry data analysis comparing outcomes of culture-negative peritonitis and different subtypes of culture-positive peritonitis in peritoneal dialysis patients

2020 ◽  
Vol 40 (1) ◽  
pp. 47-56 ◽  
Author(s):  
Htay Htay ◽  
Yeoungjee Cho ◽  
Elaine M Pascoe ◽  
Carmel Hawley ◽  
Philip A Clayton ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Primary Outcome ◽  
Catheter Removal ◽  
Dialysis Patients ◽  
Gram Positive ◽  
Pseudomonas Species ◽  
Gram Negative Organisms ◽  
Culture Positive ◽  
Culture Negative ◽  
Related Mortality

Background: The outcomes of culture-negative peritonitis in peritoneal dialysis (PD) patients have been reported to be superior to those of culture-positive peritonitis. The current study aimed to examine whether this observation also applied to different subtypes of culture-positive peritonitis. Methods: This multicentre registry study included all episodes of peritonitis in adult PD patients in Australia between 2004 and 2014. The primary outcome was medical cure. Secondary outcomes were catheter removal, hemodialysis transfer, relapsing/recurrent peritonitis and peritonitis-related death. These outcomes were analyzed using mixed effects logistic regression. Results: Overall, 11,122 episodes of peritonitis occurring in 5367 patients were included. A total of 1760 (16%) episodes were culture-negative, of which 77% were medically cured. Compared with culture-negative peritonitis, the odds of medical cure were lower in peritonitis caused by Staphylococcus aureus (adjusted odds ratio (OR) 0.62, 95% confidence interval (CI) 0.52–0.73), Pseudomonas species (OR 0.20, 95% CI 0.16–0.26), other gram-negative organisms (OR 0.48, 95% CI 0.41–0.56), polymicrobial organisms (OR 0.30, 95% CI 0.25–0.35), fungi (OR 0.02, 95% CI 0.01–0.03), and other organisms (OR 0.61, 95% CI 0.49–0.76), while the odds were similar in other (non-staphylococcal) gram-positive organisms (OR 1.11, 95% CI 0.97–1.28). Similar results were observed for catheter removal and hemodialysis transfer. Compared with culture-negative peritonitis, peritonitis-related mortality was significantly higher in culture-positive peritonitis except that due to other gram-positive organisms. There was no difference in the odds of relapsing/recurrent peritonitis between culture-negative and culture-positive peritonitis. Conclusion: Culture-negative peritonitis had superior outcomes compared to culture-positive peritonitis except for non-staphylococcal gram-positive peritonitis.

Rate of Synthetic Oligosaccharide Degradation as a Novel Measure of Amylase Activity in Peritoneal Dialysis Patients

2008 ◽  
Vol 28 (3) ◽  
pp. 296-304 ◽  
Author(s):  
Elvia García–López ◽  
Andrzej Werynski ◽  
Olof Heimbürger ◽  
José C. Divino Filho ◽  
Bengt Lindholm ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Amylase Activity ◽  
Ex Vivo ◽  
Total Activity ◽  
Activity Level ◽  
Dialysis Patients ◽  
Ex Vivo Model ◽  
Patient Groups ◽  
Uremic Patients ◽  
The Relationship

Background Plasma α–amylase activity is elevated in uremic patients but lower in peritoneal dialysis (PD) patients using icodextrin in comparison to healthy controls. We studied the rate by which an exogenous oligosaccharide (maltoheptaose; G7) is degraded ex vivo by amylase in plasma from PD patients treated with glucose or icodextrin PD solutions. Methods Plasma amylase (pancreatic and total) activity and concentration were measured in 11 controls and in PD patients treated with glucose ( n = 11) and icodextrin ( n = 19). The plasma was spiked with G7 and/or synthetic amylase and the metabolites formed were measured by HPLC following incubation at 37°C for 4 hours. Results The relationship between amylase activity and amylase concentration was similar in all patients and controls. The G7 degradation rate was slower in plasma from icodextrin patients but it was also reduced in patients using glucose compared with the controls, in spite of the higher amylase activity in the glucose group. Normalization (by spiking) of patient plasma with porcine amylase increased but did not normalize the speed of G7 degradation. At a given endogenous amylase activity level, the efficiency of G7 degradation was similar for both patient groups. Conclusions An ex vivo model to study the relationship between amylase activity and the actual rate of carbohydrate (represented by G7) breakdown was developed and showed that PD patients using glucose and icodextrin degrade G7 at a slower speed than controls. This suggests that amylase-mediated carbohydrate metabolism is reduced in PD patients. Further clinical studies are needed to confirm if these findings hold true also in other groups of uremic patients with varying degrees of kidney failure, as well as in patients undergoing hemodialysis.

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 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
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