Diminished Appetite Predicts Mortality of Chinese Peritoneal Dialysis Patients

2013 ◽  
Vol 16 (3) ◽  
pp. 241-249 ◽  
Author(s):  
Baoyan Huang ◽  
Zijuan Zhou ◽  
Hong Xu ◽  
Haiyun Wang ◽  
Bingyan Liu ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Clinical Characteristics ◽  
Average Length ◽  
Inflammatory Marker ◽  
Survival Curve ◽  
Dialysis Patients ◽  
Treatment Information ◽  
Kaplan Meier

Background:Many maintenance dialysis patients experience a common cluster of symptoms, including diminished appetite (anorexia). This symptom has been associated with reduced quality of life and increased mortality in this population.Aim:The aim of this study was to determine whether diminished appetite is a significant predictor of negative clinical outcomes in patients on peritoneal dialysis (PD).Method:A longitudinal prospective study was conducted in 98 patients receiving PD in Beijing, China. Clinical characteristics, nutritional and inflammatory marker levels, and related peritoneal treatment information were collected. The appetite status and serum albumin levels were assessed initially and reevaluated monthly during the first year of follow-up. All patients were followed for nearly 5 years or until death. Data were collected about mortality, hospitalization, and peritonitis.Results:The mean age of participants was 60.3 ± 14.4, and 22.8% reported diminished appetite. At baseline, female sex, cardiovascular disease, and prealbumin level were the significant predictors of appetite. The average length of follow-up was 39 (range: 2–57) months. The Kaplan–Meier survival curve showed the survival rate was lower in patients reporting diminished appetite than for patients reporting normal appetite. Multivariate analysis indicated that diminished appetite, diabetes, ferritin, and serum albumin levels were independent predictors of mortality.Conclusion:Self-reported appetite was a predictor of clinical characteristics and outcome for patients receiving PD. Conducting appetite evaluation periodically is recommended as a nursing strategy to improve care for these patients.

scholarly journals Elevated TG/HDL-C and Non-HDL-C/HDL-C Ratios Predict Mortality in Peritoneal Dialysis Patients

2020 ◽  
Author(s):  
Wenkai Xia ◽  
Xiajuan Yao ◽  
Yan Chen ◽  
Jie Lin ◽  
Volker Vielhauer ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Cox Regression ◽  
Predictive Accuracy ◽  
Serum Triglyceride ◽  
Hdl Cholesterol ◽  
Atherogenic Dyslipidemia ◽  
Dialysis Patients ◽  
Cox Regression Analysis ◽  
Kaplan Meier

Abstract Background and Aims: Dyslipidemia is common in patients with chronic kidney disease and particular prevalent in patients receiving peritoneal dialysis. However, whether markers of atherogenic dyslipidemia correlate with outcomes in dialysis patients as in the general population is uncertain. Here, we investigated the prognostic value of the serum triglyceride/HDL cholesterol (TG/HDL-C) ratio and non-HDL-C/HDL-C ratio in peritoneal dialysis patients to predict all-cause mortality. Methods 214 PD patients were retrospectively analyzed from January 2011 to December 2015, with a median follow-up of 59 months. We used receiver operating curves (ROC) to determine the optimal threshold for TG/HDL-C and non-HDL/HDL-C ratios at baseline to predict OS during follow-up. Prognostic values were accessed by univariate and multivariate COX regression analysis and Kaplan-Meier curve. A predictive nomogram was developed to predict prognosis for overall survival, and the predictive accuracy was evaluated by concordance index (c-index). Results The optimal cut-off values for TG/HDL-C ratio and non-HDL-C/HDL-C ratio were 1.94 and 2.86, respectively. A high TG/HDL-C ratio and a high non-HDL-C/HDL-C ratio strongly correlated with worse OS in PD patients. Multivariate analysis demonstrated that elevated TG/HDL-C ratio as well as non-HDL/HDL-C ratios were independent markers to predict reduced OS. The TG/HDL-C ratio (HR 2.60, 95% CI 1.40–4.83, P = 0.002) was superior to non-HDL-C/HDL-C ratio based on hazard ratio (HR 2.43, 95% CI 1.09–5.40, P = 0.029). Conclusion TG/HDL-C ratio and non-HDL-C/HDL-C were identified as potential prognostic biomarkers in PD patients. The proposed nomograms can be utilized for prediction of OS in PD patients.

Patient and Technique Survival on Capd in Turkey

2001 ◽  
Vol 21 (6) ◽  
pp. 602-606 ◽  
Author(s):  
◽  
Cengiz Utaş
Keyword(s):  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Patient Survival ◽  
Albumin Level ◽  
University Hospital ◽  
Mortality And Morbidity ◽  
Technique Survival ◽  
Kaplan Meier ◽  
Acceptable Method

Objective To analyze the status of continuous ambulatory peritoneal dialysis (CAPD) in 12 centers in Turkey. Design Retrospective study of CAPD technique and patient outcome. Setting University hospital renal units. Patients 334 patients [205 males (61%), 129 (39%) females; mean age 42.2 ± 13.8 years; mean follow-up time 23.5 ± 18.3 months] beginning CAPD between March 1992 and December 1999, and having a minimum follow-up of 3 months. Outcome Measure Patient survival, technique survival, and duration of hospitalization. Results Mean weekly Kt/V urea was 1.9 ± 0.8, weekly creatinine clearance was 62.9 ± 8.5 L/1.73 m2, and mean serum albumin level was 3.7 ± 0.6 g/dL. 93 patients (28%) were withdrawn from peritoneal dialysis due to death (12.6%), transplantation (3.9%), transfer to hemodialysis (8.7%), patient failure to adapt (1.5%), and other reasons (1.2%). The major causes of death were cardiovascular disease (60%), infection (19%), malignancy (2%), and others (19%). Cox proportional hazard model analysis indicated age, serum albumin levels, comorbidity, and functional status affected survival and hospitalization ( p < 0.05), whereas gender and Kt/V did not ( p > 0.05). Estimation of patient survival by Kaplan–Meier analysis showed 94.2%, 88.6%, 84.5%, and 68.9% at 1, 2, 3, and 5 years respectively. Technique survival estimate by Kaplan–Meier analysis was 96.6%, 91.1%, 90.4%, and 77.4% at 1, 2, 3, and 5 years respectively. Conclusion Peritoneal dialysis is an acceptable method of renal replacement therapy in Turkey. There is controversy regarding the usefulness of Kt/V in predicting mortality and morbidity.

scholarly journals Nutritional predictors of mortality in prevalent peritoneal dialysis patients.

2016 ◽  
Vol 63 (1) ◽  
Author(s):  
Sylwia Malgorzewicz ◽  
Michal Chmielewski ◽  
Malgorzata Kaczkan ◽  
Paulina Borek ◽  
Monika Lichodziejewska-Niemierko ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Total Cholesterol ◽  
Body Mass ◽  
Survival Curve ◽  
Skinfold Thickness ◽  
Predictors Of Mortality ◽  
Model Following ◽  
Kaplan Meier ◽  
Independent Association ◽  
Cox Analysis

Malnutrition remains one of the major predictors of mortality in peritoneal dialysis (PD) patients. The aim of the study was to evaluate the nutritional status of prevalent PD patients, and to determine the best predictors of outcome among anthropometric and laboratory indices of nutrition. The study included 106 prevalent PD patients from a single university-based unit. Anthropometric assessment at baseline included: body mass, body mass index (BMI), skinfold thickness, lean body mass (LBM), content of body fat (%F), mid-arm muscle circumference (MAMC). Laboratory analysis comprised of albumin and total cholesterol. Additionally, each patient underwent a subjective global assessment (SGA). The patients were followed for 36 months. Survival analyses were made with the Kaplan-Meier survival curve and the Cox proportional hazard model. Following SGA, malnutrition was diagnosed in 30 (28%) patients. Importantly, eight of the malnourished patients (27%) were nevertheless overweight or obese. Body weight and BMI showed complete lack of association with the outcome. In Kaplan-Meier analysis low: LBM, MAMC, albumin and cholesterol were significantly related to mortality. Cox analysis revealed that, following adjustment, LBM below median was independently associated with poor outcome (hazard ratio [HR] 3.15, 95% confidence interval [CI] 1.17-8.49, p=0.02). Moreover, the lowest quartile of total cholesterol showed independent association with mortality (HR 8.68, CI 2.14-35.21, p

scholarly journals Serum albumin and von Willebrand factor: possible markers for early detection of vascular damage in children undergoing peritoneal dialysis

2016 ◽  
Vol 39 (4) ◽  
pp. 111 ◽  
Author(s):  
Nuran Cetın ◽  
Nadide M Sav ◽  
Duran Karabel ◽  
Ali Yildirim ◽  
Bilal Yıldız
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Early Detection ◽  
Serum Albumin ◽  
Von Willebrand Factor ◽  
Independent Predictor ◽  
Left Ventricular ◽  
Dialysis Patients ◽  
Von Willebrand ◽  
Willebrand Factor

Purpose: Cardiovascular diseases are the main causes of morbidity and mortality in children with end-stage renal disease and the relationships among several relevant potential biomarkers were investigated in pediatric peritoneal dialysis patients. Methods: Serum homocysteine, von Willebrand factor (vWF), apolipoproteins A and B, lipoprotein-a, high sensitive-CRP, hemoglobin, phosphorus and parathyroid hormone (PTH) levels, systolic (SBP) and diastolic (DBP) blood pressure, carotid intima-media thickness (cIMT) and left ventricular mass index (LVMI) were measured in 21 pediatric peritoneal dialysis patients and control subjects. Results: All risk factors were higher in patients than controls. LVMI values were negatively correlated with hemoglobin and positively correlated with PTH and phosphorus levels (p=0.007, r= - 0.573; p=0.013, r= 0.532 and p=0.035, r= 0.461, respectively). cIMT was negatively associated with serum albumin and positively correlated with vWF levels and with SBP and DBP (p=0.006, r= - 0.578; p=0.039, r= 0.453; p=0.02, r= 0.503; p=0.024, r= 0.491, respectively). Robust regression analyses showed that hemoglobin was an independent predictor of LVMI and serum albumin was an independent predictor of cIMT. Conclusion: Only uremia-related factors were independent risk factors for predicting LVMI and cIMT. Hemoglobin level may be a critical factor in the development of left ventricular hypertrophy; therefore, effective treatment of anemia is crucial. Low serum albumin and high hsCRP and vWF levels, and their correlations with cIMT, indicate these patients could be at risk of developing malnutrition–inflammation–atherosclerosis syndrome and suggest that serum albumin and vWF levels may be useful markers for early detection of vascular damage.

Twenty-year outcomes in patients with newly diagnosed glaucoma: mortality and visual function

2018 ◽  
Vol 102 (12) ◽  
pp. 1663-1666
Author(s):  
Christopher King ◽  
Justin C Sherwin ◽  
Gokulan Ratnarajan ◽  
John F Salmon
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Open Angle Glaucoma ◽  
Survival Curve ◽  
Visual Outcome ◽  
Field Analysis ◽  
Time To Death ◽  
Kaplan Meier ◽  
Two Stages

Background/aimsTo determine the mortality within 20 years of diagnosis of chronic open-angle glaucoma (COAG) and visual acuity and visual field progression of a cohort followed for 20 years.MethodsTwenty years following the diagnosis of COAG in 68 of 436 (16%) patients seen in a glaucoma case-finding clinic, visual and mortality outcomes were audited from medical records. Causes of death were obtained from general practitioner records and death certificates. Probability of death was calculated using a Kaplan-Meier survival curve. The visual field of each eye of survivors was graded using a nine-stage severity scale. Visual outcome was analysed at the 20-year follow-up visit.ResultsFrom 68, 14 (21%) were lost to follow-up. In the remaining 54, 20 (37%) were alive 20 years after diagnosis. Of 63% who died, mean age of death was 84 years, most commonly due to vascular disease. Mean age at presentation of those who died was 73.7 years versus 63.2 years for survivors (P=0.001). The median time to death was 16 years. On visual field analysis, nearly half (48.9%) of eyes did not deteriorate, but 28.3% eyes deteriorated by more than two stages. Those who died had worse final visual acuity than survivors (P<0.001). Three who died were registered severely visually impaired mainly from macular disease, but no survivors were registered (P<0.001).ConclusionIn this cohort, approximately two-thirds of patients with glaucoma died within 20 years of diagnosis. In most older patients with glaucoma, the overall goal of preventing visual handicap and blindness is achievable 20 years after diagnosis.

The Incidence Prognosis and Risk Factors of Cognitive Impairment in Maintenance Haemodialysis Patients

2018 ◽  
Vol 47 (1-3) ◽  
pp. 101-108 ◽  
Author(s):  
Renhua Lu ◽  
Chenqi Xu ◽  
Yan Li ◽  
Ling Yu ◽  
Xinghua Shao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Diastolic Pressure ◽  
Survival Curve ◽  
Maintenance Haemodialysis ◽  
Kaplan Meier ◽  
Education Status ◽  
Independent Risk Factors ◽  
Meier Survival Curve

Objective: To investigate the incidence and the prognosis of cognitive impairment (CI) and to find out the risk factors associated with the outcome in maintenance haemodialysis (MHD) patients. Methods: Enrolled the patients who met the criteria as below: MHD (≥3 months) patients before July 2014, ≥18 years old and could carry on the cognitive function test (Montreal Cognitive Assessment [MoCA]). All enrolled patients were divided into 2 groups: CI group (MoCA < 26) and non-CI group (MoCA ≥26). All patients were followed up for 36 months. The incidence, demography data, medical history, haemodialysis data, laboratory examination and prognosis of CI in haemodialysis patients were prospectively compared and analyzed. Multivariate logistic regression analysis was used to investigate the risk factors of CI. Kaplan-Meier survival curve was used for survival analysis. Results: In the present study, 219 patients were enrolled. The ratio of male to female was 1.46: 1. Age was 60.07 ± 12.44 and dialysis vintage was 100.79 ± 70.23 months. One hundred thirteen patients’ MoCA scores were lower than 26 were divided into CI group. Education status (OR 3.428), post-dialysis diastolic pressure (OR 2.234) and spKt/V (OR 1.982) were independent risk factors for CI in MHD patients. During the follow-up period, 15 patients died (13.2%) in the CI group and 5 died (4.72%) in the non-CI group (p < 0.05). The Kaplan-Meier survival curve analysis showed that the survival rate of patients with CI was lower than that of non-CI group in MHD patients during 3 years follow-up (p = 0.046). Conclusion: CI is one of the most common complications in MHD patients. The mortality is high in patients who had CI. Education status, post-dialysis diastolic pressure and spKt/V are independent risk factors for CI in MHD patients.

Abstract 14845: Masquerading Bundle Branch Block: An Electrocardiographic Marker of Poor Prognosis

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Thiago G Schroder e Souza ◽  
Rômulo L Almeida ◽  
Gabriel P Targueta ◽  
Sandro P Felicioni ◽  
Virginia B Cerutti Pinto ◽  
...  
Keyword(s):  
Poor Prognosis ◽  
Survival Curve ◽  
Pacemaker Implantation ◽  
Epidemiological Data ◽  
Cardiac Conduction ◽  
Conduction Delay ◽  
S Wave ◽  
Bundle Branch Block ◽  
Kaplan Meier

Introduction: Masquerading bundle branch block (MBBB) is a rare cardiac conduction anomaly characterized in the Electrocardiogram (EKG) by Right Bundle Branch Block in the precordial leads and Left Bundle Branch Block in frontal leads. The available evidence indicates that it carries poor prognosis and that it is often underdiagnosed. We studied epidemiological peculiarities, electrocardiographic features and prognosis of this rare kind of ventricular conduction delay. Methods: In a review of over 600,000 EKGs from the database of Tele-Electrocardiography department of Dante Pazzanese Institute of Cardiology during the last seven years, we found twenty-five cases of MBBB. Diagnostic criteria were presence of QRS ≥ 0.12 s, dominant positive waves in V1, left axis deviation and absent or minimal S wave in DI and aVL. Epidemiological data was collected for each EKG and the follow-up of patient′s health status was assessed by telephone contact. Kaplan-Meier survival curves were based on the following endpoints: mortality, pacemaker implantation and the composite of both. Results: We identified twenty-five cases (21 males and 4 females) of MBBB. The average age was 69 (±14) years. Sinus rhythm was present in 17 patients (68%), atrial fibrillation in 7 (28%) and atrial flutter in one (4%). Average heart rate, PR interval, QRS length, QTc and QRS axis were, respectively: 70 (±17) bpm, 205 (±50) ms, 159 (±24) ms, 463 (±37) ms and -76° (±6) degrees. Follow-up data was successfully obtained from 15 patients: 4 (26.6%) had a pacemaker implanted, 7 (46.6%) died and 9 had combined endpoints (60%). According to the Kaplan-Meier survival curve, at 48 months, the estimated ratios of death, pacemaker implantation or combined endpoints were 41.4%, 38.9% and 80.2%, respectively. Conclusions: MBBB represents a high-risk condition and, although rare, this EKG pattern should be taken into consideration due to the poor prognosis associated with its presence.

Longitudinal Trends in Quality of Life and Physical Function in Frail Older Dialysis Patients: A Comparison of Assisted Peritoneal Dialysis and In-Center Hemodialysis

2019 ◽  
Vol 39 (2) ◽  
pp. 112-118 ◽  
Author(s):  
Osasuyi Iyasere ◽  
Edwina Brown ◽  
Fabiana Gordon ◽  
Helen Collinson ◽  
Richard Fielding ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Peritoneal Dialysis ◽  
Mixed Model ◽  
Rating Scale ◽  
Depression Scale ◽  
Dialysis Patients ◽  
The Impact ◽  
Assisted Peritoneal Dialysis

Background In-center hemodialysis (HD) has been the standard treatment for older dialysis patients, but reports suggest an associated decline in physical and cognitive function. Cross-sectional data suggest that assisted peritoneal dialysis (aPD), an alternative treatment, is associated with quality of life (QoL) outcomes that are comparable to in-center HD. We compared longitudinal changes in QoL between modalities. Methods We enrolled 106 aPD patients, matched with 100 HD patients from 20 renal centers in England and Northern Ireland. Patients were assessed quarterly for 2 years using the Hospital Anxiety and Depression Scale (HADS), SF-12 physical and mental scores, symptom score, Illness Intrusiveness Rating Scale (IIRS), Barthel's score, and the Renal Treatment Satisfaction Questionnaire (RTSQ). Mixed model analysis was used to assess the impact of dialysis modality on these outcomes during follow-up. P values were adjusted for multiple significance testing. Results Multivariate analysis showed no difference in any of the outcome measures between aPD and HD. Longitudinal trends in outcomes were also not significantly different. Higher age at baseline was associated with lower IIRS and RTSQ scores during follow-up. One-hundred and twenty-five (60.6%) patients dropped out of the study: 59 (28.6%) died, 61 (29.6%) withdrew during follow-up, and 5 (2.5%) were transplanted. Conclusions Quality of life outcomes in frail older aPD patients were equivalent to those receiving in-center HD. Assisted PD is thus a valid alternative to HD for older people with end-stage kidney disease (ESKD) wishing to dialyze at home.

scholarly journals Genetic defects of CHM and visual acuity outcome in 24 choroideremia patients from 16 Japanese families

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Takaaki Hayashi ◽  
Shuhei Kameya ◽  
Kei Mizobuchi ◽  
Daiki Kubota ◽  
Sachiko Kikuchi ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Survival Curve ◽  
Japanese Patients ◽  
Outcome Data ◽  
High Rate ◽  
Exon 2 ◽  
Pathogenic Variants ◽  
Kaplan Meier ◽  
Whole Exome

Abstract Choroideremia (CHM) is an incurable progressive chorioretinal dystrophy. Little is known about the natural disease course of visual acuity in the Japanese population. We aimed to investigate the genetic spectrum of the CHM gene and visual acuity outcomes in 24 CHM patients from 16 Japanese families. We measured decimal best-corrected visual acuity (BCVA) at presentation and follow-up, converted to logMAR units for statistical analysis. Sanger and/or whole-exome sequencing were performed to identify pathogenic CHM variants/deletions. The median age at presentation was 37.0 years (range, 5–76 years). The mean follow-up interval was 8.2 years. BCVA of the better-seeing eye at presentation was significantly worsened with increasing age (r = 0.515, p < 0.01), with a high rate of BCVA decline in patients > 40 years old. A Kaplan–Meier survival curve suggested that a BCVA of Snellen equivalent 20/40 at follow-up remains until the fifties. Fourteen pathogenic variants, 6 of which were novel [c.49 + 5G > A, c.116 + 5G > A, p.(Gly176Glu, Glu177Ter), p.Tyr531Ter, an exon 2 deletion, and a 5.0-Mb deletion], were identified in 15 families. No variant was found in one family only. Our BCVA outcome data are useful for predicting visual prognosis and determining the timing of intervention in Japanese patients with CHM variants.

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