Association of Peritoneal Dialysis Clinic Size with Clinical Outcomes

2009 ◽  
Vol 29 (3) ◽  
pp. 285-291 ◽  
Author(s):  
Laura C. Plantinga ◽  
Nancy E. Fink ◽  
Fredric O. Finkelstein ◽  
Neil R. Powe ◽  
Bernard G. Jaar
Keyword(s):  
Cohort Study ◽  
Peritoneal Dialysis ◽  
Clinical Outcomes ◽  
Patient Outcomes ◽  
Cardiovascular Mortality ◽  
Cardiovascular Events ◽  
Cox Models ◽  
All Cause Mortality ◽  
The Relationship ◽  
Technique Failure

Objective Very few studies have addressed the relationship between number of peritoneal dialysis (PD) patients treated at a clinic (PD clinic size) and clinical outcomes. In a national prospective cohort study of incident PD patients ( n = 236, from 26 clinics), we examined whether being treated at a larger PD clinic [>50 PD patients ( n = 3 clinics) vs <50 PD patients ( n = 23 clinics)] was associated with better patient outcomes, including fewer switches to hemodialysis, fewer cardiovascular events, lower cardiovascular mortality, and lower all-cause mortality. Methods Multivariable Cox models were used to assess relative hazards (RHs) for modality switches, cardiovascular events, cardiovascular deaths, and all-cause deaths by PD clinic size. All models were adjusted for demographics, comorbidities, laboratory values, and clinic years in operation. Results Being treated at a clinic with >50 patients was associated with fewer switches to hemodialysis (RH = 0.13, 95% CI 0.06 – 0.31) and fewer cardiovascular events (RH = 0.62, 95% CI 0.06 – 0.98). No associations of PD clinic size with cardiovascular or all-cause mortality were seen. Conclusion PD patients treated at clinics with greater numbers of PD patients may have better outcomes in terms of technique failure and cardiovascular morbidity. PD clinic size may act as a proxy of greater PD experience, more focus on the modality, and better PD practices at the clinic, resulting in better outcomes.

scholarly journals Association of Ambulatory Blood Pressure with All-Cause Mortality and Cardiovascular Outcomes in Peritoneal Dialysis Patients

2020 ◽  
Vol 45 (6) ◽  
pp. 890-899
Author(s):  
Shuqi Dai ◽  
Yun Chen ◽  
Da Shang ◽  
Xiaolin Ge ◽  
Qionghong Xie ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Clinical Outcomes ◽  
Ambulatory Blood Pressure ◽  
Cardiovascular Mortality ◽  
Cardiovascular Events ◽  
Independent Predictor ◽  
Blood Pressure Monitoring ◽  
Pressure Monitoring ◽  
All Cause Mortality

<b><i>Background:</i></b> Ambulatory blood pressure monitoring is the gold standard for the diagnosis of hypertension, but its effects on all-cause mortality and cardiovascular outcomes in peritoneal dialysis (PD) patients remain uncertain. We aimed to investigate the association between ambulatory blood pressure and clinical outcomes in PD patients. <b><i>Methods:</i></b> A prospective, observational cohort study was conducted in PD patients enrolled from March 2001 to July 2018 and followed until October 2019. Blood pressure was evaluated using 24-h ambulatory blood pressure monitoring. The endpoints included all-cause mortality, cardiovascular mortality, and cardiovascular events. Multivariable Cox regression was used to identify the associations between ambulatory blood pressure and endpoints. Subsequently, multivariable logistic regression was conducted to identify factors associated with elevated pulse pressure (PP). <b><i>Results:</i></b> A total of 260 PD patients (154 men, 59.2%) were recruited. The median follow-up duration was 40.7 months. Our studies revealed that PP was an independent predictor of all-cause mortality (hazard ratio [HR], 1.018; 95% CI, 1.001–1.034; <i>p</i> = 0.032), cardiovascular mortality (HR, 1.039; 95% CI, 1.017–1.061; <i>p</i> &#x3c; 0.001), and cardiovascular events (HR, 1.028; 95% CI, 1.011–1.046; <i>p</i> = 0.001). Systolic blood pressure was an independent predictor of cardiovascular mortality (HR, 1.023; 95% CI, 1.007–1.040; <i>p</i> = 0.005) and cardiovascular events (HR, 1.018; 95% CI, 1.006–1.030; <i>p</i> = 0.003). Vascular calcification was significantly associated with elevated PP (OR, 3.069; 95% CI, 1.632–5.772; <i>p</i> = 0.001). <b><i>Conclusion:</i></b> 24-h ambulatory PP was the most significant predictor of all blood pressure indicators for clinical outcomes in PD patients.

scholarly journals P1515IMPACT OF POLYPHARMACY ON ALL-CAUSE MORTALITY, ALL-CAUSE HOSPITALIZATION AND CARDIOVASCULAR EVENTS IN INITIAL JAPANESE HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Tatsunori Toida ◽  
Reiko Toida ◽  
Shou Ebihara ◽  
Shigehiro Uezono ◽  
Hiroyuki Komatsu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Clinical Outcomes ◽  
Cardiovascular Events ◽  
Chronic Renal Disease ◽  
Risk Index ◽  
Hemodialysis Patients ◽  
Drug Prescriptions ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Background and Aims Polypharmacy (PP) is common in end-stage chronic renal disease patients, largely because of the existence of multiple comorbid conditions. PP has the potential for harm and benefits, and the association between PP and mortality and morbidity in hemodialysis patients currently remains unclear. We examined the association of PP and the risk of clinical outcomes, such as all-cause mortality, all-cause hospitalization and cardiovascular events, in initial hemodialysis patients at admission and discharge. Method Study design: Cohort study. Setting: Participants: One hundred and fifty-two initial hemodialysis patients (female vs. male, 88 vs. 64; mean age, 70.3 years) were enrolled between February 2015 and March 2018 at the Nobeoka Prefectural Hospital and Chiyoda Hospital. Predictor: Patients were divided into 2 groups according to PP (6 or more drug prescriptions, or less) during admission and discharge for the initiation of hemodialysis. Outcomes: All-cause mortality, all-cause hospitalization and cardiovascular events (hospitalization due to stroke, ischemic heart disease or peripheral artery disease) during the mean 2.8-year follow-up. Measurements: Hazard ratios (HRs) were estimated using Cox’s model for the relationships between PP and the clinical outcomes, and adjusted for potential confounders, including age, sex, body mass index, systolic and diastolic blood pressure, Charlson comorbidity risk index, hemoglobin, serum levels of albumin, albumin-corrected Ca, phosphate, parathyroid hormone, C-reactive protein and NT-proBNP; and use of erythropoietin stimulating agents. The group with 5 or less drug prescriptions was set as reference. Results Among the patients in this cohort study, the number of prescribed drugs per patient averaged 7.4 at admission and 6.9 at discharge for initial hemodialysis. One hundred (65.8%) and 94 patients (61.8%) had PP at admission and discharge, respectively. During follow-up, 20 patients died, 71 patients were hospitalized and 25 patients had cardiovascular events. PP at admission is significantly associated with cardiovascular events (HR 8.50, 95%CI 1.45-49.68). Furthermore, PP at discharge is significantly associated with all-cause hospitalization and cardiovascular events (HR 1.95, 95%CI 1.01-3.70; HR 53.16, 95%CI 2.70-104.62, respectively). However, PP is not significantly associated with all-cause mortality at admission or discharge. Conclusion Among Japanese patients starting hemodialysis, PP may be associated with clinical outcomes. However, it remains unclear whether PP is the direct cause of the outcomes or is simply a marker for increased risk of outcomes.

scholarly journals Serum magnesium and cardiovascular mortality in peritoneal dialysis patients: a 5-year prospective cohort study

2018 ◽  
Vol 120 (4) ◽  
pp. 415-423 ◽  
Author(s):  
Hongjian Ye ◽  
Peiyi Cao ◽  
Xiaodan Zhang ◽  
Jianxiong Lin ◽  
Qunying Guo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Peritoneal Dialysis ◽  
Prospective Cohort Study ◽  
Cardiovascular Mortality ◽  
Prospective Cohort ◽  
Cox Regression ◽  
Serum Magnesium ◽  
Study Endpoint ◽  
Lower Serum ◽  
All Cause Mortality

AbstractThe aim of this study was to explore the association between serum Mg and cardiovascular mortality in the peritoneal dialysis (PD) population. This prospective cohort study included prevalent PD patients from a single centre. The primary outcome of this study was cardiovascular mortality. Serum Mg was assessed at baseline. A total of 402 patients (57 % male; mean age 49·3±14·9 years) were included. After a median of 49·9 months (interquartile range: 25·9–68·3) of follow-up, sixty-two patients (25·4 %) died of CVD. After adjustment for conventional confounders in multivariate Cox regression models, being in the lower quartile for serum Mg level was independently associated with a higher risk of cardiovascular mortality, with hazards ratios of 2·28 (95 % CI 1·04, 5·01), 1·41 (95 % CI 0·63, 3·16) and 1·62 (95 % CI 0·75, 3·51) for the lowest, second and third quartiles, respectively. A similar trend was observed when all-cause mortality was used as the study endpoint. Further analysis showed that the relationships between lower serum Mg and higher risk of cardiovascular and all-cause mortality were present only in the female subgroup, and not among male patients. The test for interaction indicated that the associations between lower serum Mg and cardiovascular and all-cause mortality differed by sex (P=0·008 andP=0·011, respectively). In conclusion, lower serum Mg was associated with a higher risk of cardiovascular and all-cause mortality in the PD population, especially among female patients.

Impact of Early Nephrology Referral on Mortality and Hospitalization in Peritoneal Dialysis Patients

2008 ◽  
Vol 28 (4) ◽  
pp. 371-376 ◽  
Author(s):  
Kai Ming Chow ◽  
Cheuk Chun Szeto ◽  
Man Ching Law ◽  
Bonnie Ching-Ha Kwan ◽  
Chi Bon Leung ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Cardiovascular Mortality ◽  
Univariate Analysis ◽  
Maintenance Hemodialysis ◽  
All Cause Mortality ◽  
Poor Outcomes ◽  
The Relationship ◽  
Late Referral ◽  
Relevant Factors

Objectives Several studies have examined the possible association between late referral to a nephrologist and mortality on maintenance hemodialysis. However, we lack information on the benefit of early nephrologist referral in patients receiving peritoneal dialysis (PD). Patients and Methods In an inception cohort of 102 consecutive PD patients identified in a single center between 2003 and 2004, we sought to determine whether late nephrologist referral was associated with poor outcomes. The primary end point was all-cause mortality. The effects of early referral to a multidisciplinary low clearance clinic on cardiovascular mortality and length of hospitalization were also evaluated. Results Of 102 incident PD patients, 61 subjects (59.8%) were referred early to the nephrologist (more than 3 months) before dialysis initiation. During the study period of 284.9 patient-years (median follow-up period 36.8 months), 25 patients died, 12 due to cardiovascular causes. Both cardiovascular and all-cause mortality were significantly increased among PD patients with late referral, but the relationship between late referral and all-cause mortality was mitigated substantially by adjusting for relevant factors. In univariate analysis, late nephrology referral was associated with increased cardiovascular mortality, with a hazard ratio of 5.43 (95% confidence interval 1.46 – 20.21, p = 0.012). Annual adjusted days of hospitalization were similar between the early and late nephrology referral groups. Conclusions A comprehensive analysis of incident PD subjects confirmed the significant relationship between late nephrology referral and all-cause and cardiovascular mortality. A causal relationship remains to be established and validated.

scholarly journals Coronary Artery Calcification Score as a Predictor of All-Cause Mortality and Cardiovascular Outcome in Peritoneal Dialysis Patients

2015 ◽  
Vol 36 (2) ◽  
pp. 163-170 ◽  
Author(s):  
Qionghong Xie ◽  
Xiaolin Ge ◽  
Da Shang ◽  
Yun Li ◽  
Huanqing Yan ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Coronary Artery ◽  
Cardiovascular Mortality ◽  
Coronary Artery Calcification ◽  
Cardiovascular Events ◽  
Cox Regression ◽  
Independent Predictor ◽  
Coronary Artery Calcification Score ◽  
Calcification Score ◽  
All Cause Mortality

Background This study aimed to examine whether the coronary artery calcification score (CaCS) was associated with the prognosis of peritoneal dialysis (PD) patients. Methods Adult PD patients who were clinically stable for at least 2 months were recruited for this prospective, observational cohort study. Coronary artery calcification was assessed using multislice spiral computed tomography and was recorded according to the Agatston score. The end-points including all-cause mortality, cardiovascular events, and cardiovascular mortality were assessed. Multivariate Cox regression was used to identify independent predictors of all-cause mortality, cardiovascular events (CVEs), and cardiovascular mortality. Results A total of 179 PD patients (86 men) with a mean age of 63.5 ± 14.8 years were recruited for this study. Coronary artery calcification scores ranging from 0 to 5,257 were stratified as follows: no (CaCS = 0, n = 54), low (0 < CaCS < 400, n = 72), and high (CaCS ≥ 400, n = 53) calcification. The follow-up duration was 30.6 ± 16.2 (24 – 63) months. Compared with the no calcification group, patients with a higher CaCS were older and had lower diastolic blood pressure, residual renal function, and serum albumin, and higher HbA1C and serum insulin. Multivariate Cox regression revealed that the CaCS was an independent predictor for all the 3 endpoints after adjustment in PD patients. Conclusions CaCS was an independent predictor of all-cause mortality, cardiovascular events, and cardiovascular mortality in patients receiving peritoneal dialysis.

MO704THE PROGNOSTIC IMPACT OF WEIGHT GAIN AFTER PERITONEAL DIALYSIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Win Hlaing Than ◽  
Jack K C Ng ◽  
Gordon C K Chan ◽  
Winston Fung ◽  
Cheuk Chun Szeto
Keyword(s):  
Weight Loss ◽  
Body Weight ◽  
Peritoneal Dialysis ◽  
Weight Gain ◽  
Clinical Outcomes ◽  
Patient Survival ◽  
Survival Rates ◽  
Overweight And Obesity ◽  
Technique Survival ◽  
Technique Failure

Abstract Background and Aims The prevalence of obesity has increased over the past decade in patients with End Stage Kidney Disease (ESKD). Obesity at the initiation of peritoneal dialysis (PD) was reported to adversely affect clinical outcomes. However, there are few studies on the prognostic relevance of weight gain after PD. Method We reviewed the change in body weight of 954 consecutive PD patients from the initiation of dialysis to 2 years after they remained on PD. Clinical outcomes including patient survival, technique survival, and peritonitis rate in the subsequent two years were reviewed. Results The mean age was 60.3 ± 12.2 years; 535 patients (56.1%) were men and 504 (52.8%) had diabetes. After the first 2 years on PD, the average change in body weight was 1.2± 5.1 kg; their body weight was 63.0 ± 13.3 kg; body mass index (BMI) 24.4 ± 4.4 kg/m2. The patient survival rates in the subsequent two years were 64.9%, 75.0%, and 78.9% (log rank test, p = 0.008) for patients with weight loss ≥3 kg during the first 2 years of PD weight change between -3 and +3 kg, and weight gain ≥3 kg, respectively. The corresponding technique survival rates in the subsequent two years were 93.1%, 90.1%, 91.3%, respectively (p = 0.110), and the peritonitis rates were 0.7±1.5, 0.6±1.7, and 0.6±1.1 episodes per patient-year, respectively (p = 0.3). When the actual BMI after the first 2 years of PD was categorized into underweight, normal weight, marginal overweight, overweight, and obesity groups, the patient survival rates in the subsequent two years were 77.3%, 75.2%, 73.3%, 74.3%, and 75.9%, respectively (p= 0.005), and technique survival 98.0%, 91.9%, 88.0%, 92.8%, and 81.0%, respectively (p= 0.001). After adjusting for confounding clinical factors by multivariate Cox regression models, weight gain ≥ 3kg during the first 2 years of PD was an independent protective factor for technique failure (adjusted hazard ratio [AHR] 0.049; 95% confidence interval [CI] 0.004-0.554, p = 0.015), but was an adverse predictor of patient survival (AHR 2.338, 95%CI 1.149-4.757, p = 0.019). In contrast, weight loss ≥ 3kg during the first 2 years of PD did not predict subsequent patient or technique survival. Conclusion Weight gain during the first 2 years of PD confers a significant risk of subsequent mortality but appears to be associated with a lower risk of technique failure. The mechanism of this discordant risk prediction deserves further study.

scholarly journals Acute cardiovascular events and all-cause mortality in patients with hyperthyroidism: a population-based cohort study

2017 ◽  
Vol 176 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Olaf M Dekkers ◽  
Erzsébet Horváth-Puhó ◽  
Suzanne C Cannegieter ◽  
Jan P Vandenbroucke ◽  
Henrik Toft Sørensen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Cardiovascular Events ◽  
Population Based ◽  
Arterial Embolism ◽  
Registration System ◽  
Increased Risk ◽  
All Cause Mortality

Objective Several studies have shown an increased risk for cardiovascular disease (CVD) in hyperthyroidism, but most studies have been too small to address the effect of hyperthyroidism on individual cardiovascular endpoints. Our main aim was to assess the association among hyperthyroidism, acute cardiovascular events and mortality. Design It is a nationwide population-based cohort study. Data were obtained from the Danish Civil Registration System and the Danish National Patient Registry, which covers all Danish hospitals. We compared the rate of all-cause mortality as well as venous thromboembolism (VTE), acute myocardial infarction (AMI), ischemic and non-ischemic stroke, arterial embolism, atrial fibrillation (AF) and percutaneous coronary intervention (PCI) in the two cohorts. Hazard ratios (HR) with 95% confidence intervals (95% CI) were estimated. Results The study included 85 856 hyperthyroid patients and 847 057 matched population-based controls. Mean follow-up time was 9.2 years. The HR for mortality was highest in the first 3 months after diagnosis of hyperthyroidism: 4.62, 95% CI: 4.40–4.85, and remained elevated during long-term follow-up (>3 years) (HR: 1.35, 95% CI: 1.33–1.37). The risk for all examined cardiovascular events was increased, with the highest risk in the first 3 months after hyperthyroidism diagnosis. The 3-month post-diagnosis risk was highest for atrial fibrillation (HR: 7.32, 95% CI: 6.58–8.14) and arterial embolism (HR: 6.08, 95% CI: 4.30–8.61), but the risks of VTE, AMI, ischemic and non-ischemic stroke and PCI were increased also 2- to 3-fold. Conclusions We found an increased risk for all-cause mortality and acute cardiovascular events in patients with hyperthyroidism.

scholarly journals Comparative Risk of Incidence and Clinical Outcomes of COVID-19 among Proton Pump Inhibitor and Histamine-2 Receptor Antagonist Users: A Nationwide Retrospective Cohort Study

2021 ◽  
Author(s):  
Jimyung Park ◽  
Seng Chan You ◽  
Jaehyeong Cho ◽  
Chan Hyuk Park ◽  
Woon Shin ◽  
...  
Keyword(s):  
Cohort Study ◽  
South Korea ◽  
Receptor Antagonist ◽  
Clinical Outcomes ◽  
Respiratory Disease ◽  
Proton Pump ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Large Scale ◽  
All Cause Mortality

Abstract Background: This study aimed to evaluate incidence risk and severe clinical outcomes in COVID-19 disease among short-term users of acid-suppressants in South Korea.Methods: This retrospective cohort study, conducted using a nationwide claims database for South Korea, used data from patients with COVID-19 tested between January 1 and May 15, 2020. Patients aged over 18 years and prescribed proton pump inhibitors (PPI) or histamine-2 receptor antagonist (H2RA) for more than 7 days were identified. Primary outcome was COVID-19 while secondary outcomes were all-cause mortality, hospitalization with respiratory disease, or intensive respiratory intervention. Large-scale propensity scores were used to match patients, while the Cox proportional hazard model was utilized to evaluate any association between exposure and outcome(s). The risk estimates were calibrated by using 123 falsification endpoints.Results: We identified 26,166 PPI users and 62,117 H2RA users. After propensity score matching, compared to H2RA use, PPI use was not significantly associated with lower risk of COVID-19 (calibrated hazard ratio [HR], 0.81 [95% confidence interval (CI), 0.30–2.19]); moreover, PPI use was not associated with adverse clinical outcomes in COVID-19, namely, hospitalization with respiratory disease (calibrated HR, 0.88 [95% CI, 0.72–1.08]), intensive respiratory interventions (calibrated HR, 0.92 [95% CI, 0.46–1.82]), except for all-cause mortality (calibrated HR, 0.54 [95% CI, 0.31–0.95]).Conclusions: In this study, we found that the PPI user was not associated with risk of COVID-19 compared to H2RA users. There was no significant relationship between severe clinical outcomes of COVID-19 and exposure to PPI compared with H2RA, except for all-cause mortality.

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