Impact of assistance on peritonitis due to breach in aseptic procedure in diabetic patients: A cohort study with the RDPLF data

Background: Diabetic patients often have physical impairment that could lead to manipulation errors in peritoneal dialysis (PD) and touch contamination. Nurse assistance in diabetic PD patients is known to help prevent peritonitis. We made the hypothesis that this lower risk of peritonitis was observed thanks to prevention of breach in aseptic procedure. We evaluated the impact of nurse-assisted PD on specific causes of peritonitis, especially on peritonitis due to a breach in aseptic procedure. Methods: This was a retrospective observational study of the data from the French Language Peritoneal Dialysis Registry. All diabetic patients older than age 18 years starting PD in France between 1 January 2012 and 31 December 2015 were included in the study. The event of interest was the first peritonitis event due to a breach in aseptic procedure. Death, kidney transplantation and peritonitis due to another mechanism were considered as competing events. We examined the association of the covariates with all the possible outcomes using a subdistribution hazard model developed for survival analysis in the presence of competing risks. Results: Four thousand one hundred one diabetic patients incident in PD were included in the study. At least one peritonitis event occurred in 1611 patients over the study period. A breach in aseptic procedure was reported in 441/1611 cases (27.3%): 209/575 (36.3%) in the self-care PD group, 56/217 (25.8%) in the family-assisted PD group and 176/819 (21.5%) in the nurse-assisted PD group. Both nurse and family assistance were associated with a lower risk of peritonitis due to breach in aseptic procedure in bivariate analysis. After adjustment on age, modified Charlson index, sex and diabetic nephropathy, patients treated by nurse-assisted PD (subdistribution hazard ratio (sd-HR) 0.52, 95% confidence interval (CI) 0.40–0.67) and those treated by family-assisted PD (sd-HR 0.70, 95% CI 0.51–0.95) had a lower likelihood of peritonitis due to a connection error compared to self-care PD in multivariate analysis. The modality of assistance was not associated with other causes of peritonitis in the multivariate analysis. Conclusion: While both nurse-assisted PD and family-assisted PD were associated with lower risk of peritonitis due to a breach in aseptic procedure compared to self-care PD in our study, the protective effect was greater with nurse assistance.

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Impact of diuresis and number of exchanges on Continuous Ambulatory Peritoneal Dialysis related peritonitis risk in RDPLF registry.

Bulletin de la Dialyse à Domicile ◽

10.25796/bdd.v3i2.55153 ◽

2020 ◽

Vol 3 (2) ◽

pp. 83-92

Author(s):

Clément Vachey ◽

Caroline Roubiou ◽

Catherine Bresson-Vautrin ◽

Cécile Courivaud

Keyword(s):

Risk Factor ◽

Peritoneal Dialysis ◽

Kidney Transplantation ◽

Competing Risks ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Lower Risk ◽

Diabetic Patients ◽

Increased Risk ◽

The Mean ◽

The Impact

Introduction Peritonitis is still a frequent complication among patients undergoing peritoneal dialysis (PD) and it’s associated with a significant morbimortality. The aim of our study was to investigate the impact of diuresis volume and number of exchanges (NE) on continuous ambulatory peritoneal dialysis (CAPD) related peritonitis risk. Methods This study was performed with data from the French peritoneal dialysis registry (RDPLF). We included every incident patient in the registry from January 2010 to November 2019 who had at least an adequacy evaluation. Peritonitis risk was assessed firstly by estimating a peritonitis rate per year undergoing PD and secondly by focusing on time to first peritonitis, taking into account competing risks (kidney transplantation, switch to hemodialysis, PD withdrawal whatever the cause or death). Patients whose diuresis was <500mL/24 hours were considered oliguric. Results We included 620 patients in our analysis. The mean age was 72,9 (standard deviation (SD)=15,1). Two hundred and six (39,55%) had at least one peritonitis episode. No difference was observed between oliguric patients and the others. However, we noticed an increased risk in patients with a NE≥22 per week (HR=1,55, P=0,0005 and HR=1,47, P=0,02 considering competing risks). We also observed a lower risk in diabetic patients HR=0,74, p=0,02 and HR=0,77, p=0,0497). Conclusion We didn’t find any impact of diuresis volume on peritonitis risk. Whereas, the NE seems to be a considerable risk factor, especially when it’s superior to 22 per week.

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Insulin Resistance as a Predictor of Cardiovascular Disease in Patients on peritoneal dialysis

Peritoneal Dialysis International ◽

10.3747/pdi.2012.00037 ◽

2013 ◽

Vol 33 (4) ◽

pp. 411-418 ◽

Cited By ~ 21

Author(s):

Yun Li ◽

Lihua Zhang ◽

Yong Gu ◽

Chuanming Hao ◽

Tongying Zhu

Keyword(s):

Insulin Resistance ◽

Peritoneal Dialysis ◽

Independent Predictor ◽

Hazard Ratio ◽

Diabetic Patients ◽

Model Assessment ◽

Mortality Hazard ◽

Cv Disease ◽

The Impact ◽

Mortality Hazard Ratio

BackgroundInsulin resistance is associated with multiple risk factors for cardiovascular (CV) disease in the general population. Patients on peritoneal dialysis (PD) are more likely to develop insulin resistance. However, no evaluation of the impact of insulin resistance on CV disease morbidity or mortality in patients on PD has been performed.MethodsOur prospective cohort study included all non-diabetic patients on PD at our center ( n = 66). Insulin resistance was evaluated at baseline by the homeostasis model assessment method (HOMA-IR) using fasting glucose and insulin levels. The cohort was followed for up to 58 months (median: 41.3 months; interquartile range: 34.3 months). A multivariate Cox model was used to analyze the impact of insulin resistance on CV disease mortality.ResultsFourteen CV events occurred in the higher HOMA-IR group [IR-H (HOMA-IR values in the range 2.85 – 19.5), n = 33], but only one event occurred in the lower HOMA-IR group (IR-L (HOMA-IR values in the range 0.83 – 2.71), n = 33) during the follow-up period. Level of HOMA-IR was a significant predictor of CV events [risk ratio: 17.7; 95% confidence interval (CI): 2.10 to 149.5; p = 0.008]. In the IR-H group, 10 patients died (8 CV events), but in the IR-L group, only 4 patients died (1 CV event). Patients in the IR-H group experienced significantly higher CV mortality (hazard ratio: 9.02; 95% CI: 1.13 to 72.2; p = 0.04). Even after adjustments for age, systolic blood pressure, body mass index, C-reactive protein, triglycerides, resistin, and leptin, HOMA-IR remained an independent predictor of CV mortality (hazard ratio: 14.8; 95% CI: 1.22 to 179.1; p = 0.03).ConclusionsInsulin resistance assessed using HOMA-IR was an independent predictor of CV morbidity and mortality in a cohort of nondiabetic patients on PD. Insulin resistance is a modifiable risk factor; the reduction of insulin resistance may reduce CV risk and improve survival in this group of patients.

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Estimating sample size in the presence of competing risks – Cause-specific hazard or cumulative incidence approach?

Statistical Methods in Medical Research ◽

10.1177/0962280215623107 ◽

2015 ◽

Vol 27 (1) ◽

pp. 114-125 ◽

Cited By ~ 6

Author(s):

BC Tai ◽

ZJ Chen ◽

D Machin

Keyword(s):

Sample Size ◽

Competing Risks ◽

Cumulative Incidence ◽

Exponential Model ◽

Sample Sizes ◽

Subdistribution Hazard ◽

Competing Events ◽

Event Times ◽

The Impact

In designing randomised clinical trials involving competing risks endpoints, it is important to consider competing events to ensure appropriate determination of sample size. We conduct a simulation study to compare sample sizes obtained from the cause-specific hazard and cumulative incidence (CMI) approaches, by first assuming exponential event times. As the proportional subdistribution hazard assumption does not hold for the CMI exponential (CMIExponential) model, we further investigate the impact of violation of such an assumption by comparing the results obtained from the CMI exponential model with those of a CMI model assuming a Gompertz distribution (CMIGompertz) where the proportional assumption is tenable. The simulation suggests that the CMIExponential approach requires a considerably larger sample size when treatment reduces the hazards of both the main event, A, and the competing risk, B. When treatment has a beneficial effect on A but no effect on B, the sample sizes required by both methods are largely similar, especially for large reduction in the main risk. If treatment has a protective effect on A but adversely affects B, then the sample size required by CMIExponential is notably smaller than cause-specific hazard for small to moderate reduction in the main risk. Further, a smaller sample size is required for CMIGompertz as compared with CMIExponential. The choice between a cause-specific hazard or CMI model in competing risks outcomes has implications on the study design. This should be made on the basis of the clinical question of interest and the validity of the associated model assumption.

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Effect of metformin use on the survival outcomes in diabetic patients with resectable pancreatic cancer: A single-institutional experience and meta-analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.465 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 465-465

Author(s):

Chenwi Ambe ◽

Amit Mahipal ◽

William J. Fulp ◽

Dung-Tsa Chen ◽

Mokenge Peter Malafa

Keyword(s):

Pancreatic Cancer ◽

Multivariate Analysis ◽

Lower Risk ◽

Meta Analysis ◽

Survival Outcomes ◽

Diabetic Patients ◽

Meaningful Improvement ◽

Risk Of Death ◽

Incidence And Mortality ◽

Study Results

465 Background: Observational studies have shown that metformin use in diabetic patients decreases both cancer incidence and mortality. The aim of this study was to determine whether metformin use had a survival benefit in patients with resected pancreatic cancer. Methods: All patients with diabetes who underwent pancreatic resections for adenocarcinoma between 12/1/1986 and 4/30/2013 at our institution were identified. Patients were categorized by metformin use. Survival analysis was done using the Kaplan Meier method, with log rank test, and Cox proportional hazards multivariable regression models. The comprehensive Meta-Analysis version 2.2 was used to perform a meta-analysis using data from our study and the only other published study. Results: The study from our institution was comprised of 19 patients receiving treatment with metformin, and 25 patients not receiving metformin. There were no significant differences in major clinical and demographic characteristics between metformin and non-metformin users. The estimated median survival for metformin users was 35.3 months (95% CI 10.7 - not estimable) vs. 20.2 months (95% CI 14.4-58.6) for nonusers. The estimated 2, 3 and 5 year survival rates for non-metformin users were 42% (95% CI 22-62%), 28% (95% CI 7-55%) and 14% (95% CI 1-43%) respectively. Metformin users fared better with corresponding rates of 68% (95% CI 41-84%), 34% (95% CI 12-59%) and 34% (95% CI 12-59%) respectively. Metformin users had a 46% lower risk of death; hazard ratio 0.54 (95% CI 0.16-1.86) in a multivariate analysis, p = 0.3275. For the meta-analysis, there were a total of 111 patients from both studies. There were 46 metformin users and 65 nonusers. Metformin users had a 33% lower risk of death; the HR 0.668 (95 % CI 0.397-1.125), in a multivariate analysis p= 0.129. Conclusions: Although the findings of the current study suggests that metformin use does not significantly impact survival outcomes in diabetic patients with resected pancreatic cancer, there appears to be a clinically meaningful improvement in survival. The potential benefit of metformin should be investigated in adequately powered prospective studies.

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Policy changes and impact rises: Erythropoietin Payment Policy on Cardiovascular Outcomes of Peritoneal Dialysis Patients

10.21203/rs.3.rs-18616/v1 ◽

2020 ◽

Author(s):

I-Chun Lai ◽

Ying-Hui Hou ◽

Shih-Pi Lin ◽

Thomas T.H. Wan ◽

Feng-Jung Yang ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Cardiovascular Risk ◽

Cardiovascular Events ◽

Propensity Scores ◽

Cardiovascular Outcomes ◽

Diabetic Patients ◽

Cardiovascular Risks ◽

Before And After ◽

Cardiovascular Endpoint ◽

The Impact

Abstract Background and Purposes The change in reimbursement policy of erythropoietin application to peritoneal dialysis (PD) patients by Taiwan National Health Insurance (NHI) system provided a natural experimental venue to examine whether cardiovascular risk differs while keeping hematocrit (Hct) below 30% or over 30%. This study intended to analyze the impact of loosening erythropoietin payment criteria for PD patients on their cardiovascular outcomes. Methods Two cohorts of incident PD patients before and after the relaxation of NHI’s erythropoietin payment criteria were identified as Cohort 1 and Cohort 2, respectively, and further matched by propensity scores and then followed up for cardiovascular events. There were 1,759 patients in Cohort 1 and 2,981 patients in Cohort 2. After propensity score matching, 1,754 subjects were selected from each cohort. The outcome measures were cardiovascular events and were analyzed through Cox regressions. Findings and Conclusion For the composite cardiovascular endpoint, Cohort 2 patients had significantly lower risk than Cohort 1. The risk reduction was observed only in diabetic patients. After loosening erythropoietin payment criteria, less cardiovascular risks were observed, particularly for diabetic patients. It is concluded that for diabetic PD patients, maintaining a Hct level higher than 30% is crucial for reducing the cardiovascular risk.

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Knowledge and Self-Efficacy Towards Eating Behaviors by People Living with Diabetes Mellitus

KnE Life Sciences ◽

10.18502/kls.v6i1.8617 ◽

2021 ◽

pp. 288-298

Author(s):

Lisa Anita Sari ◽

Ani Astuti ◽

Diah Merdekawati

Keyword(s):

Diabetes Mellitus ◽

Eating Behavior ◽

Healthy Eating ◽

Self Efficacy ◽

Eating Behaviors ◽

Health Knowledge ◽

Bivariate Analysis ◽

Diabetic Patients ◽

Healthy Eating Behavior ◽

The Impact

Diabetes mellitus sufferers have metabolic issues caused by insulin disorders which indicate hyperglycemia. Behavior related to food and eating, including the amount of calories, dietary choices, setting a meal plan, and control dietary challenges are particularly important for diabetes mellitus sufferers owing to the impact of these measures on the speed with which blood glucose levels increase. With better understanding, diabetic patients can analyze their food intake and adopt appropriate eating behaviors. Self-efficacy can affect the patient’s commitment to their health. Knowledge and self-efficacy support healthy eating behavior patterns. This study aims to identify the relationship between knowledge and self-efficacy with regards to eating behaviors among people living with diabetes mellitus. Bandura’s promotion model was provided as a conceptual framework. A simple random sampling technique was used to recruit 201 participants with diabetes mellitus type 2. Data collection was via a Demographic Questionnaire, an Eating Behavior Questionnaire, a Diabetes Knowledge Questionnaire (DKQ), and a Diabetes Mellitus Self-Efficacy Questionnaire (DMSQ). Data was analysed using univariate and bivariate analysis. The results indicate that participants’ eating behavior, knowledge, and self-efficacy were at a low level. This study also indicated a significant relationship between knowledge (p < 0,000) and self-efficacy (p < 0,00) and eating behaviors. The results provide important information to suggests that community nurses should increase the knowledge about diabetes mellitus management and use self-efficacy to design effective intervention to promote healthy eating behavior to keep blood sugar in control. Keywords: eating behavior, knowledge, self-efficacy, diabetes mellitus

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The Impact of Individual Motivational Interview Based on Self-Care and Efficacy of Type 2 Diabetic Patients

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2019/749 ◽

2019 ◽

Vol 8 (46) ◽

pp. 3459-3463

Author(s):

Seyyed Sajjad Safari ◽

Mozhgan Rahnama ◽

Abdolghani Abdollahimohammad ◽

Mahin Naderifar

Keyword(s):

Motivational Interview ◽

Self Care ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

The Impact ◽

Type 2 Diabetic

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17. A Guide to Multivariate Analysis

Political Research ◽

10.1093/hepl/9780198820628.003.0017 ◽

2020 ◽

pp. 451-480

Author(s):

Sandra Halperin ◽

Oliver Heath

Keyword(s):

Multivariate Analysis ◽

Explanatory Power ◽

Ordinary Least Squares ◽

Bivariate Analysis ◽

Statistical Control ◽

Causal Explanations ◽

Multiple Factors ◽

Independent Variable ◽

Cross Tabulation ◽

The Impact

This chapter extends the principles of bivariate analysis to multivariate analysis, which takes into account more than one independent variable and the dependent variable. With multivariate analysis, it is possible to investigate the impact of multiple factors on a dependent variable of interest, and to compare the explanatory power of rival hypotheses. Multivariate analysis can also be used to develop and test multi-causal explanations of political phenomena. After providing an overview of the principles of multivariate analysis, and the different types of analytical question to which they can be applied, the chapter shows how multivariate analysis is carried out for statistical control purposes. More specifically, it explains the use of ordinary least squares (OLS) regression and logistic regression, the latter of which builds on cross-tabulation, to carry out multivariate analysis. It also discusses the use of multivariate analysis to debunk spurious relationships and to illustrate indirect causality.

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Tinzaparin Provides Lower Lipid Profiles in Maintenance Hemodialysis Patients: A Cross-Sectional Observational Study

The Scientific World JOURNAL ◽

10.1155/2014/486781 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9

Author(s):

Ming-Hsien Tsai ◽

Yu-Wei Fang ◽

Jyh-Gang Leu

Keyword(s):

Multivariate Analysis ◽

Total Cholesterol ◽

Univariate Analysis ◽

Serum Triglyceride ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Maintenance Hemodialysis ◽

Diabetic Patients ◽

Significant Difference ◽

The Impact

As a low-molecular-weight heparin, tinzaparin has effectively been used as an anticoagulant during hemodialysis sessions. However, the impact of different heparin types on dyslipidemia is still controversial. In our study, 434 chronic hemodialysis patients were evaluated. The mean age was 65 ± 13. Forty-eight patients (11%) and 386 patients (89%) were in the tinzaparin and unfractionated heparin (UFH) groups, respectively. Triglyceride had significant difference between the two groups (P=0.001) but total cholesterol, HDL, or LDL did not. In the univariate analysis, the triglyceride level was significantly associated with tinzaparin use [β: −39.9, 95% confidence interval (CI): −76.7 to −3.0], and this association remained following the multivariate analysis (β: −40.8, 95% CI: −75.1 to −6.5). The difference in serum total cholesterol level between tinzaparin and UFH became significant (β: −13, 95% CI: −24.5 to −1.56) after adjustment in the multivariate analysis. Moreover, in a subgroup analysis, male diabetic patients showed lower serum triglyceride levels with the use of tinzaparin, while older, nondiabetic, male patients showed significant advantages in total cholesterol levels with the use of tinzaparin. Based on our findings, tinzaparin shows a significant association with a lower lipid profile in patients with chronic hemodialysis when compared to UFH.

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