An Inverse Relationship between Hyperuricemia and Mortality in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

Background: The results have been inconsistent with regards to the impact of uric acid (UA) on clinical outcomes both in the general population and in patients with chronic kidney disease. The aim of this study was to study the influence of serum UA levels on mortality in patients undergoing continuous ambulatory peritoneal dialysis. Methods: Data on 492 patients from a single peritoneal dialysis unit were retrospectively analyzed. The mean age of the patients was 53.5 ± 15.3 years, with 52% being female (n = 255). The concomitant comorbidities at the start of continuous ambulatory peritoneal dialysis (CAPD) encompassed diabetes mellitus (n = 179, 34.6%), hypertension (n = 419, 85.2%), and cardiovascular disease (n = 186, 37.9%). The study cohort was divided into sex-specific tertiles according to baseline UA level. A Cox proportional hazard model was used to calculate hazard ratios (HRs) of all-cause, cardiovascular, and infection-associated mortality with adjustments for demographic and laboratory data, medications, and comorbidities. Results: Multivariate Cox regression analysis showed that, using UA tertile 1 as the reference, the adjusted HR of all-cause, cardiovascular, and infection-associated mortality for tertile 3 was 0.4 (95% confidence interval (CI) 0.24–0.68, p = 0.001), 0.4 (95% CI 0.2–0.81, p = 0.01), and 0.47 (95% CI 0.19–1.08, p = 0.1). In the fully adjusted model, the adjusted HRs of all-cause, cardiovascular, and infection-associated mortality for each 1-mg/dL increase in UA level were 0.84 (95% CI, 0.69–0.9, p = 0.07), 0.79 (95% CI, 0.61–1.01, p = 0.06), and 0.79 (95% CI, 0.48–1.21, p = 0.32) for men and 0.57 (95% CI, 0.44–0.73, p < 0.001), 0.6 (95% CI, 0.41–0.87, p = 0.006), and 0.41 (95% CI, 0.26–0.6, p < 0.001) for women, respectively. Conclusions: Higher UA levels are associated with lower risks of all-cause, cardiovascular and infection-associated mortality in women treated with continuous ambulatory peritoneal dialysis.

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Effect of statin and metformin on survival in veterans (V) with B-cell lymphoproliferative disorders (BLD).

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.1602 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 1602-1602

Author(s):

Shanthi Srinivas ◽

Melanie L. Gonzalez ◽

Sunniya Khan ◽

Arpita Gandhi ◽

Barbara Crump ◽

...

Keyword(s):

Rating Scale ◽

Cox Regression ◽

Univariate Analysis ◽

Laboratory Data ◽

Cox Regression Analysis ◽

Comorbidity Index ◽

Beta 2 Microglobulin ◽

Ecog Ps ◽

The Impact ◽

Statin Use

1602 Background: The incidence of BLD has been increasing in V. As many V are on statin and metformin for comorbid conditions, we evaluated the impact of their use on survival. Methods: In an IRB-approved protocol, we reviewed the records of 332 V diagnosed with BLD from January 1997 to Dec 2011 for demographics, height(H),weight(W), BMI,statin and metformin use, clinical and laboratory data and ECOG PS. Comorbidity was assessed using the Charlson Comorbidity Index (CCI),Kaplan-Feinstein Index (KFI) and Cumulative Illness Rating Scale (CIRS). Cox regression analysis was performed using SAS v 9.2. Results: There were 332 V with a median (M) age of 70 years (27-94). The M for H 70 inches (58-78), W 183lbs (99-356.5) and BMI 26.7 kg/m2 (15.54 -48.45). The M for hemoglobin(Hgb) 12.8 g/dl (7.3-17.4), albumin 3.9(1.2-5.4), lactate dehydrogenase( LDH) 183 IU/L (85-1905), beta 2-microglobulin 2.6 mg/dl (0.8-39) . The M for CCI was 4.7 (0.8-12), KFI 2 (0-3), CIRS15 3 (0-6), CIRS16 6(0 -14), CIRS17 1.9(0-6), CIRS18 0(0-3), CIRS19 0(0-3). M survival was 1297days(4-7468).The number of V receiving statin was 167 (51%) and metformin 46 (14%). Statin use was a predictor of survival by both univariate and multivariate analysis but metformin was a predictor only by univariate analysis. Conclusions: Statin use was an independent and significant predictor of survival in this group of V with BLD and needs to be validated in a larger group of patients. [Table: see text]

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High Glucose Concentrations in Peritoneal Dialysate are Associated with All-Cause and Cardiovascular Disease Mortality in Continuous Ambulatory Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.3747/pdi.2013.00083 ◽

2015 ◽

Vol 35 (1) ◽

pp. 70-77 ◽

Cited By ~ 21

Author(s):

Yueqiang Wen ◽

Qunying Guo ◽

Xiao Yang ◽

Xianfeng Wu ◽

Shaozhen Feng ◽

...

Keyword(s):

Cardiovascular Disease ◽

Logistic Regression ◽

Peritoneal Dialysis ◽

Cox Regression ◽

Ordinal Logistic Regression ◽

Hazard Ratio ◽

Study Cohort ◽

Cox Regression Analysis ◽

Peritoneal Dialysate ◽

Cvd Mortality

BackgroundThe effect of high peritoneal dialysate glucose concentration (PDGC) on all-cause and cardiovascular disease (CVD) mortality in peritoneal dialysis (PD) patients is unclear.ObjectiveOur study aimed to investigate the effect of high PDGC on all-cause and CVD mortality in continuous ambulatory PD (CAPD) patients.MethodsThe study enrolled 716 patients newly initiated on CAPD therapy between January 2006 and December 2010. We allocated the patients to low (<1.56%), medium (≥1.56% to <1.74%), and high (≥1.74%) average PDGC groups according to the tertile of average PDGC in the first 6 months after PD initiation. Cox regression and ordinal logistic regression were used to analyze determinants of mortality and of PDGC use respectively.ResultsMean follow-up in the study cohort was 31 ± 15 months. The all-cause mortality was 4.7 events per 100 patient-years, and the leading cause of death was CVD. Patients with a higher PDGC had significantly higher cumulative rates of all-cause (log-rank p < 0.001) and CVD mortality (log-rank p < 0.001). In Cox regression analysis, high PDGC independently predicted higher all-cause (hazard ratio: 2.63; p = 0.004) and CVD mortality (hazard ratio: 2.78; p = 0.01). Compared with a lower PDGC, a higher PDGC was significantly associated with older age [odds ratio (OR): 1.02; p < 0.001], low residual renal function (OR: 0.91; p < 0.001), and high dialysate-to-plasma ratio of creatinine (OR: 28.61; p < 0.001) in ordinal logistic regression.ConclusionsHigher PDGC is associated with higher all-cause and CVD mortality in CAPD patients.

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Angiogenic Factors and Risks of Technique Failure and Cardiovascular Events in Patients Receiving Peritoneal Dialysis

Cardiorenal Medicine ◽

10.1159/000444886 ◽

2016 ◽

Vol 6 (3) ◽

pp. 251-259

Author(s):

Masaru Matsui ◽

Ken-ichi Samejima ◽

Yukiji Takeda ◽

Katsuhiko Morimoto ◽

Miho Tagawa ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Growth Factor ◽

Cardiovascular Events ◽

Cox Regression ◽

Serum Levels ◽

Adverse Outcomes ◽

Cox Regression Analysis ◽

Technique Survival ◽

Hazard Ratios ◽

Medical University

Background: Placental growth factor (PlGF) is a member of the vascular endothelial growth factor family that acts as a pleiotropic cytokine capable of stimulating angiogenesis and accelerating atherogenesis. Soluble fms-like tyrosine kinase-1 (sFlt-1) antagonizes PlGF action. Higher levels of PlGF and sFlt-1 have been associated with cardiovascular events in patients with chronic kidney disease, yet little is known about their relationship with adverse outcomes in patients on peritoneal dialysis (PD). The aim of this study was to investigate the association of PlGF and sFlt-1 with technique survival and cardiovascular events. Methods: We measured serum levels of PlGF and plasma levels of sFlt-1 in 40 PD patients at Nara Medical University. Results: PlGF and sFlt-1 levels were significantly correlated with the dialysate-to-plasma ratio of creatinine (r = 0.342, p = 0.04 and r = 0.554, p < 0.001) although PlGF and sFlt-1 levels were not correlated with total creatinine clearance and total Kt/V. Additionally, both PlGF and sFlt-1 levels were significantly higher in patients with high transport membranes compared to those without (p = 0.039 and p < 0.001, respectively). Patients with PlGF levels above the median had lower technique survival and higher incidence of cardiovascular events than patients with levels below the median, with hazard ratios of 11.9 and 7.7, respectively, in univariate Cox regression analysis. However, sFlt-1 levels were not associated with technique survival or cardiovascular events (p = 0.11 and p = 0.10, respectively). Conclusion: Elevated PlGF and sFlt-1 are significantly associated with high transport membrane status. PlGF may be a useful predictor of technique survival and cardiovascular events in PD patients.

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Preoperative prealbumin-to-fibrinogen ratio predict Survival Outcomes in hepatocellular carcinoma patients after hepatic resection

Journal of Medical Biochemistry ◽

10.5937/jomb0-32980 ◽

2021 ◽

Author(s):

Yan Haixi ◽

Chen Shuaishuai ◽

Yang Qiong ◽

Cai Linling

Keyword(s):

Risk Factors ◽

Hepatocellular Carcinoma ◽

Cox Regression ◽

Laboratory Data ◽

Disease Free Survival ◽

Factors Affecting ◽

Cox Regression Analysis ◽

Hazard Ratios ◽

Clinicopathologic Factors ◽

Independent Risk Factors

Objective: This study aims to evaluate the clinical application of preoperative prealbumin-to-fibrinogen ratio (PFR) in the clinical diagnosis and prognostic value of hepatocellular carcinoma (HCC) patients. Methods: The clinical and laboratory data of 269 HCC patients undergoing surgical treatment from January 2012 to January 2017 in Taizhou Hospital were retrospectively analyzed. The Cox regression model was used to analyze the correlation between PFR and other clinicopathologic factors in overall survival (OS) and disease-free survival (DFS). Results: Cox regression analysis showed that PFR (hazard ratios [HR] = 2.123; 95% confidence interval [95% CI], 1.271–3.547; P = 0.004)was independent risk factors affecting the OS of HCC patients. Furthermore, a nomogram was built based on these risk factors. The C indices statistics for the OS nomogram was 0.715. Conclusion: Nomograms based on PFR can be recommended as the correct and actual model to evaluate prognosis for patients with HCC.

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The Synergistic Value of Time-Averaged Serum Albumin and Globulin in Predicting the First Peritonitis in Incident Peritoneal Dialysis Patients

Blood Purification ◽

10.1159/000504036 ◽

2019 ◽

Vol 49 (3) ◽

pp. 272-280

Author(s):

Wenyu Zhang ◽

Xichao Wang ◽

Ying Liu ◽

Yingying Han ◽

Jinping Li ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Cox Regression ◽

Cox Regression Analysis ◽

Group 4 ◽

Hazard Ratios ◽

Lower Baseline ◽

Separate Factor ◽

Categorical Groups ◽

Group 1

Background: The prognostic value of serum time-averaged albumin (TA-Alb) and time-averaged globulin (TA-Glo) combination on the peritonitis in peritoneal dialysis (PD) patients is unknown. Methods: The patients who started PD treatment between July 2013 and 2018 were included. Serum Alb and globulin (Glo) were tested at baseline and monthly during follow-up. TA-Alb and TA-Glo were calculated until first peritonitis occurred or the end of the study. PD patients were divided into 4 groups based on the medians of TA-Alb and TA-Glo separately. Cox regression was conducted to identify the hazard ratios (HRs) of peritonitis among categorical groups. Results: Three hundred and sixty-three patients were included and among them 109 patients experienced first peritonitis. Peritonitis patients had lower baseline Alb, TA-Alb, and TA-Glo levels and ultrafiltration volume. Multivariate cox regression analysis revealed that TA-Alb, TA-Glo, and baseline Alb were significantly associated with first peritonitis. The highest HR existed in Group 1 with lower Alb and lower Glo (HR 4.57, 95% CI 2.36–8.87, p < 0.001) compared with Group 4 with higher Alb and higher Glo. Conclusion: Lower TA-Glo is an independent risk factor for the first peritonitis in PD patients. Combined with lower TA-Alb will increase the predictive effect than separate factor alone.

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Advanced cancer survival in a rural community: The impact of hospice services.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e20628 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e20628-e20628

Author(s):

David Eric Cowall ◽

Veera Holdai

Keyword(s):

Lung Cancer ◽

Rural Community ◽

Cancer Survival ◽

Cox Regression ◽

P Value ◽

Cox Regression Analysis ◽

Rank Analysis ◽

Lung Cancer Patients ◽

Hazard Ratios ◽

The Impact

e20628 Background: The intensity of end-of-life (EOL) cancer care in a rural community has been previously reported (Cowall et al: J Oncol Pract 8: 40e-44e, 2012) using a random sample of all cancer deaths from Wicomico County, Maryland for calendar years 2004-2008. We now examine the impact of hospice services on survival in this same population. Methods: Significance (P-value) of diagnosis to death median survivals (MS) between different groups was calculated by log-rank analysis. Hazard ratios (HR) with 95% confidence intervals (CI) were obtained using Cox regression analysis. Results: 179 patients from our sample did not receive hospice services, and 211 were enrolled in hospice at some point during their illness. MS were 6.0 and 9.0 months respectively (P= 0.050, HR 1.222, CI 1.000-1.492). In the lung cancer subset, 54 patients did not receive hospice services and 78 were enrolled in hospice. MS were 5.0 and 7.0 months respectively (P=0.034, HR 1.468, CI 1.030-2.093). Other subsets were too small for analysis. Conclusions: Prolongedsurvival was significantly associated with hospice services in our sample, and that effect was more pronounced with lung cancer patients. The hospice effect on survival may reflect some combination of the following: hospice services result in better symptom management as well as counseling against toxic therapies at EOL and/or the bias of some patients against toxic treatments even before hospice enrollment.

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Socioeconomic trajectories and risk of hospitalization in the Moli-sani Study cohort

European Journal of Public Health ◽

10.1093/eurpub/ckz185.033 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

M Bonaccio ◽

A Di Castelnuovo ◽

S Costanzo ◽

M Persichillo ◽

A De Curtis ◽

...

Keyword(s):

Life Course ◽

Social Mobility ◽

Hospital Admissions ◽

Cox Regression ◽

Educational Achievement ◽

Study Cohort ◽

Hazard Ratios ◽

Increased Risk ◽

Direct Linkage ◽

The Impact

Abstract Background A life course approach was used to explore the impact of socioeconomic status (SES) on risk of hospitalizations for all-cause and for cardiovascular disease (CVD). Methods Longitudinal analyses on 19,999 subjects apparently free from CVD and cancer, recruited in the Moli-sani Study, Italy (2005-2010). Low and high SES in childhood, educational attainment (low/high) and SES during adulthood (measured by a score including material resources and dichotomized as low/high) defined the trajectories over life course. First hospital admissions were recorded by direct linkage with hospital discharge form registry. Hazard ratios (HR) with 95% confidence interval (95%CI) were calculated by multivariable Cox-regression. Results Over a median follow up of 7.3 y, we ascertained a total of 7,594 all-cause and 2,539 CVD hospitalizations. Poor childhood SES was associated with 11% and 17% increased risk of all-cause and CVD hospitalizations, respectively. Among subjects with poor childhood SES, an upward trajectory in education was associated with lower risk of hospital admission for all-cause (HR = 0.85; 95%CI 0.76-0.94) and CVD (HR = 0.78; 0.64-0.95), as opposed to subjects remained stably low (low education and adulthood SES). Individuals with high childhood SES, but not educational achievement, were at 26% increased risk of hospitalization for any cause, as compared to the stably high SES group, while failure to achieve both educational and material advancements was associated with 37% higher risk of CVD hospitalization. Conclusions In a large sample of healthy adults, social mobility (educational and/or material upward trajectories) was associated with lower incidence of hospital admissions for all-cause and CVD. Key messages Social mobility may counterbalance the negative health burden associated with low early-life SES. High SES in childhood poorly affects hospitalization risk if no additional achievements across life course occur.

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Prognostic value of lymphocyte cell ratios in peritoneal dialysis

Portuguese Journal of Nephrology & Hypertension ◽

10.32932/pjnh.2021.04.112 ◽

2021 ◽

Vol 35 (1) ◽

pp. 18-21

Author(s):

Roberto Marques ◽

◽

Eduarda Carias ◽

Ana Domingos ◽

Anabela Guedes ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Inflammatory Markers ◽

Cox Regression ◽

Wide Spectrum ◽

Laboratory Data ◽

High Sensitivity ◽

Residual Renal Function ◽

Cox Regression Analysis ◽

Lymphocyte Ratio ◽

Hs Crp

Background: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been introduced as useful inflammatory markers to predict the outcome of a wide spectrum of diseases, such as malignancies and cardiovascular pathologies. Limited evidence is available for their role in end-stage renal disease and dialysis patients. The aim of this study was to evaluate NLR and PLR as predictors of mortality in peritoneal dialysis (PD) patients. Methods: In this retrospective study 122 incident PD patients between 2004 and 2019 were included. Demographic, clinical and laboratory data were collected. Relationships between NLR, PLR and high-sensitivity C-reactive protein (hs-CRP) were evaluated by Spearman correlation test. Univariable and multivariable Cox regression analysis were performed to determine the association of NLR and PLR with all-cause mortality. Results: Mean levels of NLR and PLR were 3.99±2.6 and 195.5±101.7, respectively. Both NLR and PLR were significantly and positively correlated with serum hs-CRP levels (r=0.340, p<0.001 and r=0.360, p<0.001, respectively). The overall mortality rate was 18.9% after a mean follow-up of 30.2±24.0 months. On multivariable modeling, we found that higher NLR (HR=1.662, 95%CI 1.117-2.472) and higher PLR (HR=1.010, 95%CI 1.004-1.015), in addition to lower residual renal function and higher Charlson comorbidity index were significant independent predictors of poor survival, when adjusted for nutritional status. Discussion: In this study, NLR and PLR were validated as inflammatory markers and predicted survival in our PD patients. Our results suggest that NLR might be a better indicator of mortality than PLR.

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The Negative Impact of Early Peritonitis on Continuous Ambulatory Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.3747/pdi.2013.00024 ◽

2014 ◽

Vol 34 (6) ◽

pp. 627-635 ◽

Cited By ~ 11

Author(s):

Yao-Peng Hsieh ◽

Shu-Chuan Wang ◽

Chia-Chu Chang ◽

Yao-Ko Wen ◽

Ping-Fang Chiu ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Clinical Outcomes ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Cox Regression ◽

Negative Impact ◽

Serum Levels ◽

Rank Test ◽

Technique Survival ◽

The Impact ◽

Technique Failure

BackgroundPeritonitis rate has been reported to be associated with technique failure and overall mortality in previous literatures. However, information on the impact of the timing of the first peritonitis episode on continuous ambulatory peritoneal dialysis (CAPD) patients is sparse. The aim of this research is to study the influence of time to first peritonitis on clinical outcomes, including technique failure, patient mortality and dropout from peritoneal dialysis (PD).MethodsA retrospective observational cohort study was conducted over 10 years at a single PD unit in Taiwan. A total of 124 patients on CAPD with at least one peritonitis episode comprised the study subjects, which were dichotomized by the median of time to first peritonitis into either early peritonitis patients or late peritonitis patients. Cox proportional hazard model was used to analyze the correlation of the timing of first peritonitis with clinical outcomes.ResultsEarly peritonitis patients were older, more diabetic and had lower serum levels of creatinine than the late peritonitis patients. Early peritonitis patients were associated with worse technique survival, patient survival and stay on PD than late peritonitis patients, as indicated by Kaplan-Meier analysis (log-rank test, p = 0.04, p < 0.001, p < 0.001, respectively). In the multivariate Cox regression model, early peritonitis was still a significant predictor for technique failure (hazard ratio (HR), 0.54; 95% confidence interval (CI), 0.30 – 0.98), patient mortality (HR, 0.34; 95% CI, 0.13 – 0.92) and dropout from PD (HR, 0.50; 95% CI, 0.30 – 0.82). In continuous analyses, a 1-month increase in the time to the first peritonitis episode was associated with a 2% decreased risk of technique failure (HR, 0.98; 95% CI, 0.97 – 0.99), a 3% decreased risk of patient mortality (HR, 0.97; 95% CI, 0.95 – 0.99), and a 2% decreased risk of dropout from PD (HR, 98%; 95% CI, 0.97 – 0.99). Peritonitis rate was inversely correlated with time to first peritonitis according to the Spearman analysis (r = –0.64, p < 0.001).ConclusionsTime to first peritonitis is significantly correlated with clinical outcomes of peritonitis patients with early peritonitis patients having poor prognosis. Patients with shorter time to first peritonitis were prone to having a higher peritonitis rate.

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The Impact of Timing of Dialysis Initiation on Mortality in Patients with Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.3747/pdi.2013.00328 ◽

2015 ◽

Vol 35 (7) ◽

pp. 703-711 ◽

Cited By ~ 6

Author(s):

Hyung Wook Kim ◽

Su-Hyun Kim ◽

Young Ok Kim ◽

Dong Chan Jin ◽

Ho Chul Song ◽

...

Keyword(s):

Regression Analysis ◽

Peritoneal Dialysis ◽

Renal Disease ◽

Cox Regression ◽

Dialysis Initiation ◽

Cox Regression Analysis ◽

All Cause Mortality ◽

Group A ◽

Group B ◽

The Impact

BackgroundThe impact of timing of dialysis initiation on mortality is controversial in patients with peritoneal dialysis (PD). In this study, we analyzed the impact of timing of dialysis initiation on mortality in the incident PD population.MethodsIncident patients with PD were selected from the Clinical Research Center (CRC) registry for end-stage renal disease (ESRD), a prospective cohort study on dialysis in Korea. Patients were categorized into 3 groups according to the estimated glomerular filtration rate (eGFR) at the initiation of PD using the Modification of Diet in Renal Disease (MDRD) equation. Group A was defined as eGFR < 5 mL/min/1.73m2, group B as eGFR 5 – 10 mL/min/1.73m2, and group C as eGFR > 10 mL/min/1.73m2. Cox regression analysis was used to calculate the adjusted hazard ratio (HR) of mortality with group B as the reference. The primary outcome was all-cause mortality.ResultsA total of 495 incident PD patients were included. The number of patients in group A was 109, group B was 279, and group C was 107. The median follow-up period was 23 months. Multivariate Cox regression analysis showed that group A had a significantly higher risk of all-cause mortality compared with group B (HR 4.13, 95% confidence interval [CI], 1.55 – 11.03, p = 0.005) after adjustment for age, gender, cause of ESRD, serum albumin level, diabetes mellitus, and cardiovascular disease. There was no significant difference in mortality between group C and group B (HR 1.50, 95% CI, 0.59 – 3.80, p = 0.398) after adjustment for clinical variables.ConclusionAn eGFR < 5 mL/min/1.73m2at the initiation of PD was a significant risk factor for death, while an eGFR >10 mL/min/1.73m2at the initiation of PD was not associated with improved survival compared with an eGFR of 5 – 10 mL/min/1.73m2at the initiation of PD.

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