scholarly journals Glucose Exposure in Peritoneal Dialysis Is a Significant Factor Predicting Peritonitis

2020 ◽  
Vol 51 (3) ◽  
pp. 237-243
Author(s):  
Herma Uiterwijk ◽  
Casper F.M. Franssen ◽  
Johanna Kuipers ◽  
Ralf Westerhuis ◽  
Ferdau L. Nauta
Keyword(s):  
Peritoneal Dialysis ◽  
Regression Models ◽  
Cox Regression ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Low Glucose ◽  
Glucose Exposure ◽  
Prospective Longitudinal ◽  
Residual Diuresis

Introduction: Loss of residual renal function (RRF) as well as high peritoneal glucose exposure are associated with increased peritonitis frequency in peritoneal dialysis (PD) patients. Our objective was to investigate the contribution of RRF and peritoneal glucose exposure to peritonitis in PD patients. Methods: In this prospective longitudinal cohort study, 105 incident end-stage renal disease patients that started PD between January 2006 and 2015 were studied. Follow-up was 5 years with censoring at death or switch to another treatment modality. Cox regression models were used to calculate the association between glucose exposure, RRF, and peritonitis. Kaplan-Meier analysis was used to examine the difference in occurrence of peritonitis between patients with high and low glucose exposure and between those with and without residual diuresis. Results: One hundred and five patients were followed for a mean of 23 months. Fifty-one patients developed a peritonitis. Cox regression models at 6 months showed that glucose exposure and not residual diuresis significantly predicted PD peritonitis. Kaplan-Meier analysis after 6 months of follow-up showed that time to first PD peritonitis was significantly longer in the low glucose exposure group. Similarly, patients with RRF had a significantly longer interval to first peritonitis compared to patients without RRF. Conclusion: A higher exposure to glucose rather than loss of RRF is associated with an increased risk of peritonitis. This confirms the detrimental effects of glycemic harm to the peritoneal host defense on invading microorganisms and argues for the use of the lowest PD glucose concentrations possible.

The Impact Of Waist Circumference And Diabetes On Incident Of Cardiovascular Death During 9 Years Of Follow Up In General Population

2021 ◽  
Author(s):  
Man Li ◽  
Shu-xia Wang ◽  
Yong-kang Su ◽  
Jin Sun ◽  
An-hang Zhang ◽  
...  
Keyword(s):  
Waist Circumference ◽  
General Population ◽  
Regression Models ◽  
Prognostic Value ◽  
Cox Regression ◽  
Cardiovascular Death ◽  
Kaplan Meier ◽  
Obesity And Diabetes ◽  
Increased Risk

Abstract Background: It has been reported that obesity and diabetes are both the risk factors for the development of cardiovascular diseases (CVD). However, recent articles reported that compared with BMI, waist circumference (WC) can better reflect obesity, more closely related to visceral fat tissue which is positively associated with an increased risk of cardiovascular death. Moreover, few studies have both investigated the prognostic value of both WC and diabetes during a long-term follow up. We aimed to investigate whether higher level of WC measurements and diabetes were able to predict cardiovascular mortality in general population.Methods: In this prospective cohort study, a total of 1521 consecutive subjects free of clinical cardiovascular disease were included. The end point was cardiovascular death. The Kaplan-Meier method and Cox regression models were used to evaluate the cumulative risk of outcome at different WC levels with or without diabetes.Results: During a median follow up of 9.2 years, there were 265 patients had the occurrence of cardiovascular death. Kaplan-Meier survival estimates indicated that the patients with higher levels of WC (WC>94cm) coexist with diabetes had significantly increased risk of cardiovascular death (log-rank p＜0.05). After adjustment for potential confounders, multiple COX regression models showed that the incidence of cardiovascular death was significantly higher when patients with high WC coexisted with DM (HR 3.78; 95% CI: 3.35–3.98; p＜0.001).Conclusion: Patients with high WC and diabetes represent a high-risk population for cardiovascular death. WC and diabetes may provide incremental prognostic value beyond traditional risks factors.

scholarly journals Association between Aminotransferase/alanine Aminotransferase Ratio and Cardiovascular Disease mortality in Patients on Peritoneal Dialysis: A Multi-center Retrospective Study

2020 ◽  
Author(s):  
Xiaoran Feng ◽  
Yueqiang Wen ◽  
FenFen Peng ◽  
Niansong Wang ◽  
Xiaojiang Zhan ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Peritoneal Dialysis ◽  
Alanine Aminotransferase ◽  
Cox Regression ◽  
Significant Risk ◽  
Kaplan Meier ◽  
Disease Mortality ◽  
Increased Risk ◽  
Cvd Mortality

Abstract Objectives: Elevated aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio is an independent risk factor for cardiovascular disease (CVD) among the general population. However, an association between AST/ALT ratio and CVD mortality in patients on peritoneal dialysis (PD) has received little attention.Methods: A total of 2224 incident PD patients from multi-centers were enrolled from November 1, 2005, to June 30, 2017, in this retrospective cohort study. The primary endpoint was CVD mortality. Eligible patients were divided into high and normal groups according to the AST/ALT ratio cut-off for CVD mortality with the receiver operating characteristic (ROC) curve. The associations between the AST/ALT ratio and CVD mortality were evaluated by the Cox regression model.Results: Of eligible 1579 patients with a mean age of 49.3±14.6 years, 55.4% of patients were male, 18.1% of patients had diabetes, and 64.2% of patients had hypertension. The prevalence of a high AST/ALT ratio was 76.6% in the cohort population. During a follow-up period with 4659.6 patient-years, 316 patients died, of which 193 (61.1%) deaths were caused by CVD episodes. The incidence of CVD mortality in the high group was significantly higher than that in the normal group (13.1% versus 9.2%, P=0.024). Cumulative CVD mortality rates were significantly different between the two groups by Kaplan-Meier analysis [hazards ratio (HR)=1.50, 95% confidence index (CI) 1.09-2.07, P=0.014]. After adjusting for confounding factors, a higher AST/ALT ratio was independently associated with an increased risk of CVD mortality compared with their counterparts (HR=1.43, 95%CI 1.08-2.41, P=0.002). Conclusions: PD patients with high baseline AST/ALT ratio levels may be at a significant risk of CVD mortality.

scholarly journals The Impact of Waist Circumference on Incident of Cardiovascular Death During 9 Years of Follow Up in General Population

2021 ◽  
Author(s):  
Man Li ◽  
Shu-xia Wang ◽  
Yong-kang Su ◽  
Jin Sun ◽  
An-hang Zhang ◽  
...  
Keyword(s):  
Waist Circumference ◽  
General Population ◽  
Regression Models ◽  
Prognostic Value ◽  
Cox Regression ◽  
Cardiovascular Death ◽  
Kaplan Meier ◽  
Increased Risk

Abstract Background: Risk assessment is essential for the primary prevention of cardiovascular death among general population. Although studies have shown that waist circumference (WC) is positively associated with an increased risk of cardiovascular death among the general population, few studies have investigated the prognostic value of WC during a long-term follow up and the risk threshold of WC remains controversial. We aimed to investigate whether higher level of WC measurements was able to predict mortality in general population.Methods: In this prospective cohort study, a total of 1521 consecutive subjects free of clinical cardiovascular disease were included. The end point was cardiovascular death. The Kaplan-Meier method was used to evaluate the cumulative risk of outcome at different WC levels, and compared by log-rank tests. Univariate and multivariable-adjusted Cox regression models were used to investigate the association between WC and outcomes.Results: During a median follow up of 9.2 years, there were 265 patients died. Kaplan-Meier survival estimates indicated that the patients with higher levels of WC (WC> 94cm) had a significantly increased risk of cardiovascular death (log-rank p＜0.001). After adjustment for potential confounders, multiple COX regression models showed that higher level of WC was an independent predictor in developing cardiovascular death (HR 3.02; 95% CI: 1.88–3.83; p＜0.001). We saw a significant increase of (area under the curve) AUC in ROC (receiver operating characteristic) curve after addition of WC to a clinical model, for long-term cardiovascular death the increase of AUC 0.766 vs 0.642 (95% CI: 0.787–0.846 p＜0.001). The addition of WC to established risk factors significantly improved risk prediction of cardiovascular death (net reclassification index, and integrated discrimination improvement, all p＜0.05).Conclusion: Higher level of WC is significantly associated with long-term cardiovascular death. WC may provide incremental prognostic value beyond traditional risks factors.

scholarly journals Association between Aminotransferase/alanine Aminotransferase Ratio and Cardiovascular Disease mortality in Patients on Peritoneal Dialysis

2020 ◽  
Author(s):  
Xiaoran Feng ◽  
Yueqiang Wen ◽  
FenFen Peng ◽  
Niansong Wang ◽  
Xiaojiang Zhan ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Peritoneal Dialysis ◽  
Alanine Aminotransferase ◽  
Cox Regression ◽  
Significant Risk ◽  
Kaplan Meier ◽  
Disease Mortality ◽  
Increased Risk ◽  
Cvd Mortality

Abstract Background Elevated aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio is an independent risk factor for cardiovascular disease (CVD) among the general population. However, an association between AST/ALT ratio and CVD mortality in patients on peritoneal dialysis (PD) has received little attention. Methods A total of 2224 incident PD patients from multi-centers were enrolled from November 1, 2005, to June 30, 2017, in this retrospective cohort study. The primary endpoint was CVD mortality. Eligible patients were divided into high and normal groups according to the AST/ALT ratio cut-off for CVD mortality with the receiver operating characteristic (ROC) curve. The associations between the AST/ALT ratio and CVD mortality were evaluated by the Cox regression model. Results Of eligible 1579 patients with a mean age of 49.3±14.6 years, 55.4% of patients were male, 18.1% of patients had diabetes, and 64.2% of patients had hypertension. The prevalence of a high AST/ALT ratio was 76.6% in the cohort population. During a follow-up period with 4659.6 patient-years, 316 patients died, of which 193 (61.1%) deaths were caused by CVD episodes. The incidence of CVD mortality in the high group was significantly higher than that in the normal group (13.1% versus 9.2%, P=0.024). Cumulative CVD mortality rates were significantly different between the two groups by Kaplan-Meier analysis [hazards ratio (HR)=1.50, 95% confidence index (CI) 1.09-2.07, P=0.014]. After adjusting for confounding factors, a higher AST/ALT ratio was independently associated with an increased risk of CVD mortality compared with their counterparts (HR=1.43, 95%CI 1.08-2.41, P=0.002). Conclusions PD patients with high baseline AST/ALT ratio levels may be at a significant risk of CVD mortality.

scholarly journals Association between Aminotransferase/alanine Aminotransferase Ratio and Cardiovascular Disease mortality in Patients on Peritoneal Dialysis

2020 ◽  
Author(s):  
Xiaoran Feng ◽  
Yueqiang Wen ◽  
FenFen Peng ◽  
Niansong Wang ◽  
Xiaojiang Zhan ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Peritoneal Dialysis ◽  
Alanine Aminotransferase ◽  
Cox Regression ◽  
Significant Risk ◽  
Kaplan Meier ◽  
Disease Mortality ◽  
Increased Risk ◽  
Cvd Mortality

Abstract Background: Elevated aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio is an independent risk factor for cardiovascular disease (CVD) among the general population. However, an association between AST/ALT ratio and CVD mortality in patients on peritoneal dialysis (PD) has received little attention.Methods: A total of 2224 incident PD patients from multi-centers were enrolled from November 1, 2005, to June 30, 2017, in this retrospective cohort study. The primary endpoint was CVD mortality. Eligible patients were divided into high and normal groups according to the AST/ALT ratio cut-off for CVD mortality with the receiver operating characteristic (ROC) curve. The associations between the AST/ALT ratio and CVD mortality were evaluated by the Cox regression model.Results: Of eligible 1579 patients with a mean age of 49.3±14.6 years, 55.4% of patients were male, 18.1% of patients had diabetes, and 64.2% of patients had hypertension. The prevalence of a high AST/ALT ratio was 76.6% in the cohort population. During a follow-up period with 4659.6 patient-years, 316 patients died, of which 193 (61.1%) deaths were caused by CVD episodes. The incidence of CVD mortality in the high group was significantly higher than that in the normal group (13.1% versus 9.2%, P=0.024). Cumulative CVD mortality rates were significantly different between the two groups by Kaplan-Meier analysis [hazards ratio (HR)=1.50, 95% confidence index (CI) 1.09-2.07, P=0.014]. After adjusting for confounding factors, a higher AST/ALT ratio was independently associated with an increased risk of CVD mortality compared with their counterparts (HR=1.43, 95%CI 1.08-2.41, P=0.002). Conclusions: PD patients with high baseline AST/ALT ratio levels may be at a significant risk of CVD mortality.

scholarly journals Association between Aminotransferase/alanine Aminotransferase Ratio and Cardiovascular Disease mortality in Patients on Peritoneal Dialysis

2020 ◽  
Author(s):  
Xiaoran Feng ◽  
Yueqiang Wen ◽  
FenFen Peng ◽  
Niansong Wang ◽  
Xiaojiang Zhan ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Peritoneal Dialysis ◽  
Alanine Aminotransferase ◽  
Cox Regression ◽  
Significant Risk ◽  
Kaplan Meier ◽  
Disease Mortality ◽  
Increased Risk ◽  
Cvd Mortality

Abstract Objectives Elevated aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio is an independent risk factor for cardiovascular disease (CVD) among the general population. However, an association between AST/ALT ratio and CVD mortality in patients on peritoneal dialysis (PD) has received little attention.Methods A total of 2224 incident PD patients from multi-centers were enrolled from November 1, 2005, to June 30, 2017, in this retrospective cohort study. The primary endpoint was CVD mortality. Eligible patients were divided into high and normal groups according to the AST/ALT ratio cut-off for CVD mortality with the receiver operating characteristic (ROC) curve. The associations between the AST/ALT ratio and CVD mortality were evaluated by the Cox regression model.Results Of eligible 1579 patients with a mean age of 49.3±14.6 years, 55.4% of patients were male, 18.1% of patients had diabetes, and 64.2% of patients had hypertension. The prevalence of a high AST/ALT ratio was 76.6% in the cohort population. During a follow-up period with 4659.6 patient-years, 316 patients died, of which 193 (61.1%) deaths were caused by CVD episodes. The incidence of CVD mortality in the high group was significantly higher than that in the normal group (13.1% versus 9.2%, P=0.024). Cumulative CVD mortality rates were significantly different between the two groups by Kaplan-Meier analysis [hazards ratio (HR)=1.50, 95% confidence index (CI) 1.09-2.07, P=0.014]. After adjusting for confounding factors, a higher AST/ALT ratio was independently associated with an increased risk of CVD mortality compared with their counterparts (HR=1.43, 95%CI 1.08-2.41, P=0.002).Conclusions PD patients with high baseline AST/ALT ratio levels may be at a significant risk of CVD mortality.

Association between pulse pressure and ischaemic stroke in elderly patients with hypertension

2020 ◽  
pp. postgradmedj-2019-137357
Author(s):  
Jiayi Huang ◽  
Lin Liu ◽  
Yu-Qing Huang ◽  
Kenneth Lo ◽  
Yu-Ling Yu ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Pulse Pressure ◽  
Regression Models ◽  
Cox Regression ◽  
Antihypertensive Drugs ◽  
Uncontrolled Blood Pressure ◽  
Increased Risk ◽  
Elderly Hypertensive ◽  
Male Patients

BackgroundThe association between pulse pressure (PP) and the risk of first ischaemic stroke (IS) is inconsistent. Therefore, we evaluated the association between PP and the risk of first IS among elderly hypertensive population in China.MethodsThis was a retrospective cohort study. Patients with hypertension and aged ≥60 years were recruited. Multivariate Cox regression was performed to evaluate the association between PP and the risk of IS. We further stratified the regression models into subgroups and test for interaction to assess whether the associations were modified by other covariates.ResultsA total of 3315 patients with hypertension (44.49% male; mean age 71.41±7.20 years) were included, and 206 cases of IS occurred with a median follow-up of 5.5 years. The results showed that per SD mm Hg increment in PP was associated with a 17% (95% CI 1.05 to 1.40, p=0.0172) increased risk of IS. Moreover, the HR of IS for the highest quartile of PP was 1.46 (95% CI 1.18 to 1.73, p=0.0011, p for trend <0.001) comparing with the lowest quartile of PP. Subgroup analysis showed that population aged ≥70 years, male, patients with smoking or drinking habit, diabetes at baseline, being overweight, with uncontrolled blood pressure or did not take antihypertensive drugs have a higher risk for IS.ConclusionsWe found that PP was significantly associated with IS and was an independent risk factor for IS.

Predictors of Residual Renal Function Decline in Peritoneal Dialysis Patients: ThebalANZ Trial

2017 ◽  
Vol 37 (3) ◽  
pp. 283-289 ◽  
Author(s):  
Htay Htay ◽  
Yeoungjee Cho ◽  
Elaine M. Pascoe ◽  
Darsy Darssan ◽  
Carmel Hawley ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Demographic Data ◽  
Urine Volume ◽  
Renin Angiotensin System ◽  
Residual Renal Function ◽  
Angiotensin System ◽  
Low Glucose ◽  
Glucose Exposure

ObjectivePreservation of residual renal function (RRF) is associated with improved survival. The aim of the present study was to identify independent predictors of RRF and urine volume (UV) in incident peritoneal dialysis (PD) patients.MethodsThe study included incident PD patients who were balANZ trial participants. The primary and secondary outcomes were RRF and UV, respectively. Both outcomes were analyzed using mixed effects linear regression with demographic data in the first model and PD-related parameters included in a second model.ResultsThe study included 161 patients (mean age 57.9 ± 14.1 years, 44% female, 33% diabetic, mean follow-up 19.5 ± 6.6 months). Residual renal function declined from 7.5 ± 2.9 mL/min/1.73 m2at baseline to 3.3 ± 2.8 mL/min/1.73 m2at 24 months. Better preservation of RRF was independently predicted by male gender, higher baseline RRF, higher time-varying systolic blood pressure (SBP), biocompatible (neutral pH, low glucose degradation product) PD solution, lower peritoneal ultrafiltration (UF) and lower dialysate glucose exposure. In particular, biocompatible solution resulted in 27% better RRF preservation. Each 1 L/day increase in UF was associated with 8% worse RRF preservation ( p = 0.007) and each 10 g/day increase in dialysate glucose exposure was associated with 4% worse RRF preservation ( p < 0.001). Residual renal function was not independently predicted by body mass index, diabetes mellitus, renin angiotensin system inhibitors, peritoneal solute transport rate, or PD modality. Similar results were observed for UV.ConclusionsCommon modifiable risk factors which were consistently associated with preserved RRF and residual UV were use of biocompatible PD solutions and achievement of higher SBP, lower peritoneal UF, and lower dialysate glucose exposure over time.

scholarly journals Convexity subarachnoid hemorrhage in lobar intracerebral hemorrhage

Neurology ◽  
2020 ◽  
Vol 94 (9) ◽  
pp. e968-e977 ◽  
Author(s):  
Nicolas Raposo ◽  
Andreas Charidimou ◽  
Duangnapa Roongpiboonsopit ◽  
Michelle Onyekaba ◽  
M. Edip Gurol ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracerebral Hemorrhage ◽  
Regression Models ◽  
Cox Regression ◽  
Bleeding Risk ◽  
Superficial Siderosis ◽  
Amyloid Angiopathy ◽  
Increased Risk ◽  
Cortical Superficial Siderosis

ObjectiveTo investigate whether acute convexity subarachnoid hemorrhage (cSAH) associated with acute lobar intracerebral hemorrhage (ICH) increases the risk of ICH recurrence in patients with cerebral amyloid angiopathy (CAA).MethodsWe analyzed data from a prospective cohort of consecutive survivors of acute spontaneous lobar ICH fulfilling the Boston criteria for possible or probable CAA (CAA-ICH). We analyzed baseline clinical and MRI data, including cSAH (categorized as adjacent or remote from ICH on a standardized scale), cortical superficial siderosis (cSS), and other CAA MRI markers. Multivariable Cox regression models were used to assess the association between cSAH and recurrent symptomatic ICH during follow-up.ResultsWe included 261 CAA-ICH survivors (mean age 76.2 ± 8.7 years). Of them, 166 (63.6%, 95% confidence interval [CI] 57.7%–69.5%) had cSAH on baseline MRI. During a median follow-up of 28.3 (interquartile range 7.2–57.0) months, 54 (20.7%) patients experienced a recurrent lobar ICH. In Cox regression, any cSAH, adjacent cSAH, and remote cSAH were independent predictors of recurrent ICH after adjustment for other confounders, including cSS. Incidence rate of recurrent ICH in patients with cSAH was 9.9 per 100 person-years (95% CI 7.3–13.0) compared with 1.2 per 100 person-years (95% CI 0.3–3.2) in those without cSAH (adjusted hazard ratio 7.5, 95% CI 2.6–21.1).ConclusionIn patients with CAA-related acute ICH, cSAH (adjacent or remote from lobar ICH) is commonly observed and heralds an increased risk of recurrent ICH. cSAH may help stratify bleeding risk and should be assessed along with cSS for prognosis and clinical management.

Association between Peritoneal Glucose Exposure and Peritonitis in Peritoneal Dialysis Patients: TheBalANZ Trial

2017 ◽  
Vol 37 (4) ◽  
pp. 407-413 ◽  
Author(s):  
Melissa Nataatmadja ◽  
Yeoungjee Cho ◽  
Elaine M. Pascoe ◽  
Darsy Darssan ◽  
Carmel M. Hawley ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Peritoneal Dialysis ◽  
High Glucose ◽  
Controlled Trial ◽  
Exposure Group ◽  
Peritoneal Membrane ◽  
Randomized Controlled ◽  
Increased Risk ◽  
Low Glucose ◽  
Glucose Exposure

BackgroundGlucose is the primary osmotic medium used in most peritoneal dialysis (PD) solutions, and exposure to glucose has been shown to exert detrimental effects both locally, at the peritoneal membrane, and systemically. Moreover, high dialysate glucose exposure may predispose patients to an increased risk of peritonitis, perhaps as a result of impaired host defences, vascular disease, and damage to the peritoneal membrane.MethodsIn this post-hoc analysis of a multicenter, multinational, open-label randomized controlled trial of neutral pH, low-glucose degradation product (GDP) versus conventional PD solutions ( balANZ trial), the relationship between peritonitis rates of low (< 123.1 g/day) versus high (≥ 123.1 g/day) dialysate glucose exposure was evaluated in 177 incident PD patients over a 2-year study period.ResultsPeritonitis rates were 0.44 episodes per patient-year in the low-glucose exposure group and 0.31 episodes per patient-year in the high-glucose exposure group, (incidence rate ratio [IRR] 0.69, p = 0.09). There was no significant association between dialysate glucose exposure and peritonitis-free survival on univariable analysis (high glucose exposure hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.40 –1.08) or on multivariable analysis (adjusted HR 0.64, 95% CI 0.39 – 1.05). Moreover, there was no relationship between peritoneal glucose exposure and type of organism causing peritonitis. Physician-rated severity of first peritonitis episodes was similar between groups, as was rate and duration of hospital admission.ConclusionsOverall, this study did not identify an association between peritoneal dialysate glucose exposure and peritonitis occurrence, severity, hospitalization, or outcomes. A further large-scale, prospective, randomized controlled trial evaluating patient-level outcomes is merited.

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