Hypoalbuminemia, cardiac morbidity, and mortality in end-stage renal disease.

A cohort of 432 ESRD (261 hemodialysis and 171 peritoneal dialysis) patients was followed up prospectively for an average of 41 months. Baseline and annual demographic, clinical, and echocardiographic assessments were performed, as well as serial clinical and laboratory tests measured monthly while patients were on dialysis therapy. Among hemodialysis patients, after adjustment was made for age, diabetes, and ischemic heart disease, as well as hemoglobin and blood pressure levels measured serially, a 10-g/L fall in mean serum albumin level was independently associated with the the development of de novo (relative risk [RR], 2.22; P = 0.001) and recurrent cardiac failure (RR, 3.84; P = 0.003), de novo (RR, 5.29; P = 0.001) and recurrent ischemic heart disease (RR, 4.24; P = 0.005), cardiac mortality (RR, 5.60; P = 0.001), and overall mortality (RR, 4.33; P < 0.001). Among peritoneal dialysis patients, a 10-g/L fall in mean serum albumin level was independently associated with the progression of left ventricular dilation as seen on follow-up echocardiography (beta, 13.4 mL/m2; P = 0.014), the development of de novo cardiac failure (RR, 4.16; P = 0.003), and overall mortality (RR, 2.06; P < 0.001). Hypoalbuminemia, a major adverse prognostic factor in dialysis patients, is strongly associated with cardiac disease.

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The efficacy number as a predictor of morbidity and mortality in peritoneal dialysis patients.

Journal of the American Society of Nephrology ◽

10.1681/asn.v451184 ◽

1993 ◽

Vol 4 (5) ◽

pp. 1184-1191

Author(s):

M V Rocco ◽

J R Jordan ◽

J M Burkart

Keyword(s):

Peritoneal Dialysis ◽

Serum Albumin ◽

Serum Albumin Level ◽

Strong Predictor ◽

Univariate Analysis ◽

Albumin Level ◽

Dialysis Patients ◽

Plasma Urea ◽

Predicting Outcome ◽

Chronic Ambulatory Peritoneal Dialysis

The efficacy number has been proposed as a predictor of clinical outcome in patients on chronic ambulatory peritoneal dialysis (CAPD). The usefulness of this parameter in a large group of CAPD patients was analyzed. Forty-five patients who have received chronic CAPD therapy for at least 1 yr were included in the study. The efficacy number was compared with outcome as defined by mortality and days of hospitalization. Other demographic and laboratory parameters, including gender; race; presence of diabetes; serum albumin, serum creatinine, and BUN levels; and measures of peritoneal transport, including dialysate-to-plasma creatinine and dialysate-to-plasma urea ratios, were also assessed for their role in predicting outcome. Laboratory values were obtained at the initiation of CAPD and at 12 months after the start of CAPD. By univariate analysis, a low 12-month serum albumin level was the best predictor of mortality (P < 0.005), followed by a high 12-month efficacy number (P < 0.05). After adjusting for age and the presence of diabetes, these two variables remained the best predictors of mortality (P < 0.08 and < 0.09, respectively). A low initial serum albumin level was also a strong predictor of mortality (P < 0.09). By univariate analysis, the best predictor of hospitalization was a low serum albumin level obtained either initially or at 12 months (P < 0.005 for both time periods). After adjusting for age and the presence of diabetes, the 12-month serum albumin level remained a significant predictor of hospitalization (P < 0.03), whereas efficacy number was not a strong predictor (P = 0.27).(ABSTRACT TRUNCATED AT 250 WORDS)

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Serum Albumin Level as a Predictor of Incident Coronary Heart Disease: The Atherosclerosis Risk in Communities (ARIC) Study

American Journal of Epidemiology ◽

10.1093/oxfordjournals.aje.a010232 ◽

2000 ◽

Vol 151 (5) ◽

pp. 468-477 ◽

Cited By ~ 77

Author(s):

J. J. Nelson ◽

D. Liao ◽

A. R. Sharrett ◽

A. R. Folsom ◽

L. E. Chambless ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Serum Albumin ◽

Serum Albumin Level ◽

Albumin Level ◽

Incident Coronary Heart Disease ◽

Atherosclerosis Risk In Communities ◽

Atherosclerosis Risk ◽

Aric Study

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Favored serum albumin level and ICF volume after use of 1.1% aminoacid based peritoneal dialysis(PD) solution

Kidney Research and Clinical Practice ◽

10.1016/j.krcp.2012.04.604 ◽

2012 ◽

Vol 31 (2) ◽

pp. A87

Author(s):

Jong-woo Yoon ◽

Myung-jin Choi ◽

Ja-ryong Koo ◽

Young-ki Lee ◽

Jung-woo Noh

Keyword(s):

Peritoneal Dialysis ◽

Serum Albumin ◽

Serum Albumin Level ◽

Albumin Level

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Anemia is Correlated with Malnutrition and Inflammation in Croatian Peritoneal Dialysis Patients: A Multicenter Nationwide Study

Peritoneal Dialysis International ◽

10.3747/pdi.2016.00013 ◽

2017 ◽

Vol 37 (4) ◽

pp. 472-475 ◽

Cited By ~ 2

Author(s):

Josipa Radić ◽

Nikolina Bašic-Jukić ◽

Božidar Vujicić ◽

Dragan Klarić ◽

Goran Radulović ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Serum Albumin ◽

Serum Albumin Level ◽

Clinical Laboratory ◽

Binding Capacity ◽

Albumin Level ◽

Weekly Dose ◽

Anthropometric Parameters ◽

Reactive Protein ◽

Anemia Management

Malnutrition, inflammation, and anemia are common in peritoneal dialysis (PD) patients. In this study, correlations between Malnutrition Inflammation Score (MIS), laboratory and anthropometric parameters, and anemia indices in Croatian PD patients were analyzed. One hundred and one PD patients (males/females 54/47, age 58.71 ± 14.68 years, mean PD duration 21.82 ± 21.71 months) were included. Clinical, laboratory, and anthropometric parameters were measured. Statistically significant correlations between MIS and erythropoietin weekly dose per kg of body weight (ESA weekly dose), hemoglobin (Hb), and erythrocytes were found ( r = 0.439, p < 0.001; r = -0.032, p < 0.001; r = -0.435, p < 0.001), respectively. Also, statistically significant correlations were found between MIS and mean corpuscular volume ( r = 0.344, p < 0.001), iron ( r = -0.229, p = 0.021), and total iron binding capacity (TIBC) ( r = -0.362, p < 0.001), respectively. Furthermore, statistically significant correlations between ESA weekly dose and serum albumin level and body mass index (BMI) were found ( r = -0.272, p = 0.006; r = -0.269, p = 0.006), respectively. When we divided PD patients into 2 groups according Hb level (Hb ≥ 11 0 [ N = 60, 59.41 %]) and Hb < 110 [ N = 41, 40.59%]), statistically significant differences were found in MIS score (3.02 ± 2.54 vs 4.54 ± 3.54, p = 0.014), C-reactive protein (CRP) (3.52 ± 6.36 vs 7.85 ± 7.96, p = 0.005), and serum albumin level (44.22 ± 8.54 vs 39.94 ± 8.56, p = 0.003), respectively. Our findings suggest that anemia is correlated with malnutrition and inflammation in Croatian PD patients. Further studies are needed to assess whether modulating inflammatory or nutritional processes can improve anemia management in PD patients.

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Incidence and risk factors of peritoneal dialysis-related peritonitis in elderly patients: A retrospective clinical study

Peritoneal Dialysis International ◽

10.1177/0896860819879868 ◽

2020 ◽

Vol 40 (1) ◽

pp. 26-33 ◽

Cited By ~ 2

Author(s):

Haishan Wu ◽

Hongjian Ye ◽

Rong Huang ◽

Chunyan Yi ◽

Juan Wu ◽

...

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Elderly Patients ◽

Serum Albumin ◽

Serum Albumin Level ◽

Albumin Level ◽

Advanced Age ◽

Retrospective Clinical Study ◽

Technique Failure ◽

Related Mortality

Background: This study was to analyze the incidence, risk factors, and clinical outcomes of peritonitis in elderly continuous ambulatory peritoneal dialysis (CAPD) patients. Methods: Incident patients undergone CAPD from 1 January 2006 to 30 June 2015 in our center were enrolled and divided into aged < 65 years and ≥ 65 years groups. Risk factors were evaluated using a logistic regression model, and outcome comparison was evaluated using a Cox proportional model. Results: Among 1953 patients, 111(33.2%) in elderly ( n = 334) and 470 (29.0%) in younger ( n = 1619) developed at least one episode of peritonitis. Comparing with younger patients, elderly ones had a higher peritonitis rate (0.203 vs. 0.145 episodes/patient-year, p < 0.05). The multivariate Cox regression showed that advanced age (hazard ratio (HR) = 1.06, 95% confidence interval (CI) = 1.01–1.11, p = 0.015), assistant-assisted peritoneal dialysis (PD; HR = 2.64, 95% CI = 1.23–5.64, p = 0.012), higher body mass index (BMI; HR = 1.11, 95% CI = 1.02–1.20, p = 0.010), and low serum albumin level (HR = 0.94, 95% CI = 0.90–0.98, p = 0.004) were associated with increased peritonitis risk in elderly patients. Compared with younger ones with peritonitis, elderly patients had an approximately fourfold increased risk of peritonitis-related mortality (odd ratio (OR) = 3.57, 95% CI = 1.38–9.28, p = 0.009). During the cohort, peritonitis was the risk factor associated with technique failure (HR = 3.19, 95% CI = 2.33–4.39, p < 0.001) in younger patient but not in the elderly population (HR = 1.82, 95% CI = 0.84–3.94, p = 0.132). Conclusions: Elderly PD patients had higher prevalence for peritonitis and peritonitis-related mortality. Advanced age, assistant-assisted PD, a higher BMI, and lower serum albumin level were independently associated with the first episode of peritonitis in elderly patients. However, peritonitis was not the predictor of death-censored technique failure in elderly ones.

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Persistent elevation of C-reactive protein and ischemic heart disease in continuous ambulatory peritoneal dialysis patients

Proceedings 6th Russian-Korean International Symposium on Science and Technology. KORUS-2002 (Cat. No.02EX565) ◽

10.1109/korus.2002.1028074 ◽

2003 ◽

Author(s):

Soon Bae Kim ◽

Won Ki Min ◽

Jung Sik Park ◽

C.D. Hong

Keyword(s):

Heart Disease ◽

Peritoneal Dialysis ◽

Ischemic Heart Disease ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Ischemic Heart ◽

C Reactive Protein ◽

Dialysis Patients ◽

Reactive Protein ◽

Persistent Elevation

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Lower Serum Albumin Level Is Associated With an Increased Risk for Loss of Residual Kidney Function in Patients Receiving Peritoneal Dialysis

Therapeutic Apheresis and Dialysis ◽

10.1111/1744-9987.12861 ◽

2019 ◽

Vol 24 (1) ◽

pp. 72-80 ◽

Cited By ~ 2

Author(s):

Shunsuke Yamada ◽

Yasuhiro Kawai ◽

Shoji Tsuneyoshi ◽

Hiroaki Tsujikawa ◽

Hokuto Arase ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Serum Albumin ◽

Kidney Function ◽

Serum Albumin Level ◽

Albumin Level ◽

Lower Serum ◽

Residual Kidney Function ◽

Increased Risk

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Gastroparesis: An Important Cause of Hospitalization in Continuous Ambulatory Peritoneal Dialysis Patients and the Role of Erythromycin

Peritoneal Dialysis International ◽

10.1177/089686089301302s43 ◽

1993 ◽

Vol 13 (2_suppl) ◽

pp. 183-186 ◽

Cited By ~ 15

Author(s):

P. Gallar ◽

A. Oliet ◽

A. Vigil ◽

O. Ortega ◽

G. Guijo

Keyword(s):

Heart Disease ◽

Peritoneal Dialysis ◽

Ischemic Heart Disease ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Ischemic Heart ◽

Diabetic Patients ◽

Dialysis Patients ◽

Prokinetic Drugs ◽

First Cause

Gastroparesls Is a disabling complication In diabetic patients. It has been reported as the second most frequent cause of hospitalization In diabetic patients on continuous ambulatory peritoneal dialysis (CAPD). We analyzed Infectious and noninfectious complications In our CAPD patients. We Included 31 patients (12 diabetics and 19 nondiabetics) with an average time on CAPD of 14±7 months. The Incidence of peritonitis was 1.68 episodes/patient/year In diabetics and 0.84 tn nondiabetics. Nine (75%) diabetic patients had peritonitis, 5 (42%) had vomiting, and 4 (33%) had Ischemic heart disease. The hospitalization Index (days/year) was greater In diabetics: 11.83± 11.36 versus 4.16±8.84 In nondiabetics (p<0.05). Vomiting was the first cause of admission in diabetics. We were unable to control severe gastroparesls with cisapride and metoclopramide in 4 patients. Erythromycin, 100 mg/2-L bag of dialysate, improved symptoms In all of them. We concluded that gastroparesls Is an Important cause of morbidity In CAPD patients. Intraperitoneal erythromycin can Improve symptoms If other prokinetic drugs fail.

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Pulmonary Hypertension in Peritoneal Dialysis Patients: Prevalence and Risk Factors

Peritoneal Dialysis International ◽

10.1177/089686080902900214 ◽

2009 ◽

Vol 29 (2) ◽

pp. 191-198 ◽

Cited By ~ 37

Author(s):

Aydin Ünal ◽

Murat Sipahioglu ◽

Fatih Oguz ◽

Mehmet Kaya ◽

Hamit Kucuk ◽

...

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Ejection Fraction ◽

Serum Albumin ◽

Serum Albumin Level ◽

Albumin Level ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Systolic Pulmonary Artery Pressure ◽

Ventricular Ejection Fraction

Aim To investigate the prevalence of pulmonary arterial hypertension (PAH) and the possible contributing factors for PAH in patients receiving regular continuous ambulatory peritoneal dialysis (CAPD). Patients and Methods The study included 135 CAPD patients and 15 disease-free controls. Patients that had chronic obstructive pulmonary disease, severe mitral or aortic valve disease, connective tissue disease, history of pulmonary embolism, left ventricular ejection fraction <50%, or chest wall or parenchymal lung disease were excluded. All patients and controls were examined using echocardiography and bioelectrical impedance analysis. PAH was defined as systolic pulmonary artery pressure (PAP) >35 mmHg at rest. Results Mean systolic PAP was higher in the CAPD patients than in the controls (19.66 ± 11.66 vs 14.27 ± 4.55 mmHg, p = 0.001). PAH was detected in 17 (12.6%) of the 135 CAPD patients. Mean systolic PAP was significantly higher in patients with PAH than in those without PAH (42.00 ± 9.13 vs 16.44 ± 7.83 mmHg, p = 0.001). Serum albumin level and ejection fraction were lower in patients with PAH than in those without PAH ( p = 0.001 and 0.003 respectively). The ratio of extracellular water/total body water (ECW/TBW), which can reflect hydration status, was significantly higher in patients with PAH than in those without PAH ( p = 0.008). In the PD group, no patients were hypovolemic; 51 (37.8%) of the 135 PD patients were hypervolemic and 84 (62.2%) were normovolemic. Only 3 of the 17 patients with PAH were normovolemic; the rest were hypervolemic. Mean systolic PAP was significantly higher in hypervolemic PD patients (24.57 ± 14.19 mmHg) than in normovolemic PD patients (16.68 ± 7.61 mmHg) ( p = 0.001). PAP correlated with ECW/TBW ( r=0.317, p = 0.001) and left ventricular mass index (LVMI; r=0.286, p = 0.001). On the other hand, it inversely correlated with serum albumin level ( r = –0.281, p = 0.001), hemoglobin level ( r = –0.165, p = 0.044), and ejection fraction ( r = –0.263, p = 0.001). Serum albumin level, ECW/TBW, and LVMI were found in multivariate analysis to be independent risk factors for PAP. Conclusion PAH is a frequent cardiovascular complication in CAPD patients. Serum albumin level, hypervolemia, and LVMI are major risk factors for PAH. Therefore, strategies for treatment of hypervolemia, left ventricular hypertrophy, and hypoalbuminemia should be enhanced to prevent the development of PAH in CAPD patients.

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