Center-Specific Risk-Adjusted Standardized Mortality Rates on Continuous Ambulatory Peritoneal Dialysis in China

Background The aim of this study was to determine if there were centers in China with unusually high levels of risk-adjusted mortality in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods We analyzed an inception cohort commencing CAPD between 1 January 2005 and 13 August 2015, followed until death, dropout defined as discontinuation of Baxter products, loss to follow-up, or 13 November 2015, whichever occurred first. We calculated standardized mortality ratios (SMRs) from Cox proportional hazards models, adjusting for age, gender, employment status, insurance status, primary renal disease, size of peritoneal dialysis (PD) program, and year of dialysis inception. We calculated 2 SMRs, 1 from models including a fixed effect for center of treatment, and 1 from stratified models. Results In this study, there was a 9.9% annual mortality rate in China, with decreasing mortality risk over time. There was significant variation of outcomes between Chinese centers, with up to 20% of facilities having SMRs indicating a higher risk-adjusted mortality rate than average. In particular, larger centers had better than expected mortality than smaller ones. There was significant misclassification of SMRs calculated using stratification versus fixed-effects models, although both showed directionally similar results. Conclusion Despite overall satisfactory and improving outcomes, our study showed a significant proportion of PD centers with higher than expected mortality. This is a signal for further assessment of these centers in China, after which there might be a range of actions taken depending on the results of the assessment and context, bearing in mind that the variation seen may be driven by factors unrelated to quality of care or beyond the control of hospital.

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Maintained Folic Acid Supplementation Reduces the Risk of Mortality in Continuous Ambulatory Peritoneal Dialysis Patients

Blood Purification ◽

10.1159/000480222 ◽

2017 ◽

Vol 45 (1-3) ◽

pp. 28-35

Author(s):

Rong Rong ◽

Qian Zhou ◽

Jianxiong Lin ◽

Naya Huang ◽

Wei Li ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Folic Acid ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Cardiovascular Mortality ◽

Proportional Hazards ◽

Folic Acid Supplementation ◽

Cox Proportional Hazards ◽

Cutoff Value ◽

Cox Proportional Hazards Models

Background: The association between folic acid (FA) supplementation and mortality in continuous ambulatory peritoneal dialysis (CAPD) patients is unclear. Methods: FA exposure was calculated as a percentage of cumulative duration of drug usage to total follow-up duration (FA%). A total of 1,358 patients were classified by a cutoff value of FA%. The association of FA with mortality was evaluated using Cox proportional hazards models. Results: The cutoff value of FA% for predicting mortality was <34% at a median follow-up of 40.7 months. FA ≥34% was associated with decreased risk for all-cause (adjusted hazard ratios [HRs] 95% CI 0.64 [0.48-0.85] and cardiovascular mortality 0.67 (95% CI 0.47-0.97). Moreover, the adjusted HRs per 10% higher FA for all-cause and cardiovascular mortality were 0.925 (95% CI 0.879-0.973) and 0.926 (95% CI 0.869-0.988), respectively. Conclusions: Longer period of FA supplementation led to a reduction in risk of both all-cause and cardiovascular mortality in CAPD patients.

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Faster Transport Status and Mortality in Anuric Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

Blood Purification ◽

10.1159/000433416 ◽

2015 ◽

Vol 40 (2) ◽

pp. 160-166 ◽

Cited By ~ 2

Author(s):

Liping Xiong ◽

Li Fan ◽

Qingdong Xu ◽

Qian Zhou ◽

Huiyan Li ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Models ◽

Increased Risk ◽

All Cause Mortality ◽

History Of ◽

The Relationship

Background: There are limited data regarding the relationship between transport status and mortality in anuric continuous ambulatory peritoneal dialysis (CAPD) patients. Methods: According to the dialysate to plasma creatinine ratio (D/P Cr), 292 anuric CAPD patients were stratified to faster (D/P Cr ≥0.65) and slower transport groups (D/P Cr <0.65). The Cox proportional hazards models were used to evaluate the association of transport status with mortality. Results: During a median follow-up of 22.1 months, 24% patients died, 61.4% of them due to cardiovascular disease (CVD). Anuric patients with faster transport were associated with an increased risk of all-cause mortality (HR (95% CI) = 2.16 (1.09-4.26)), but not cardiovascular mortality, after adjustment for confounders. Faster transporters with pre-existing CVD had a greater risk for death compared to those without any history of CVD. Conclusion: Faster transporters were independently associated with high all-cause mortality in anuric CAPD patients. This association was strengthened in patients with pre-existing CVD.

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Predictors of Survival in Continuous Ambulatory Peritoneal Dialysis Patients: A Five-Year Prospective Study

Peritoneal Dialysis International ◽

10.1177/089686089601601s36 ◽

1996 ◽

Vol 16 (1_suppl) ◽

pp. 190-194 ◽

Cited By ~ 30

Author(s):

Morrell M. Avram ◽

Paul A. Fein ◽

Luigi Bonomini ◽

Neal Mittman ◽

Raphael Loutoby ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Serum Albumin ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Tertiary Care ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Term Survival ◽

Predictors Of Mortality

Our objective was to examine the influence of various demographic, clinical, and enrollment biochemical variables on the long-term survival of continuous ambulatory peritoneal dialysis (CAPD) patients. This was a prospective cohort study investigating the relationship between demographics and enrollment biochemical markers and mortality in CAPD patients in a CAPD unit in a large tertiary care teaching hospital. One hundred and sixtynine patients in the CAPD program were enrolled between 1989 and 1994, and were followed up to 60 months. Independent predictors of mortality determined by Cox proportional hazards model included age, diabetes, serum albumin and creatinine. Enrollment level of serum albumin, and creatinine can predict mortality in CAPD patients up to 60 months. Markers of visceral and somatic nutrition at enrollment are important predictors of mortality in CAPD patients up to five years.

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Risk Factors for Mortality in Chinese Patients on Continuous Ambulatory Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.3747/pdi.2013.00164 ◽

2015 ◽

Vol 35 (2) ◽

pp. 199-205 ◽

Cited By ~ 8

Author(s):

Fan Zhang ◽

Hong Liu ◽

Xiaoli Gong ◽

Fuyou Liu ◽

Youming Peng ◽

...

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Patient Survival ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Hazards Model ◽

Kaplan Meier

ObjectiveThe intent of this study was to evaluate the clinical outcome and risk factors affecting mortality of the continuous ambulatory peritoneal dialysis (CAPD) patients in a single peritoneal dialysis (PD) center over a period of 10 years.Patients and methodsWe retrospectively analyzed patients on PD from June 2001 to June 2011. The clinical and biochemical data were collected from the medical records. Clinical variables included gender, age at the start of PD, smoking status, body mass index (BMI), cause of end-stage renal disease (ESRD), presence of diabetes mellitus and blood pressure. Biochemical variables included hemoglobin, urine volume, residual renal function (RRF), serum albumin, blood urea nitrogen (BUN), creatinine, total cholesterol, triglyceride, comorbidities, and outcomes. Survival curves were made by the Kaplan-Meier method. Univariate and multivariate analyses to identify mortality risk factors were performed using the Cox proportional hazard regression model.ResultsA total of 421 patients were enrolled, 269 of whom were male (63.9%). The mean age at the start of PD was 57.9 ± 14.8 years. Chronic glomerulonephritis was the most common cause of ESRD (39.4%). Estimation of patient survival by Kaplan-Meier was 92.5%, 80.2%, 74.4%, and 55.7% at 1, 3, 5, and 10 years, respectively. Patient survival was associated with age (hazard ratio [HR]: 1.641 [1.027 – 2.622], p = 0.038), cardiovascular disease (HR: 1.731 [1.08 – 2.774], p = 0.023), hypertriglyceridemia (HR: 1.782 [1.11 – 2.858], p = 0.017) in the Cox proportional hazards model analysis. Estimation of technique survival by Kaplan-Meier was 86.7%, 68.8%, 55.7%, and 37.4% at 1, 3, 5, and 10 years, respectively. In the Cox proportional hazards model analysis, age (HR: 1.672 [1.176 – 2.377], p = 0.004) and hypertriglyceridemia (HR: 1.511 [1.050 – 2.174], p = 0.026) predicted technique failure.ConclusionThe PD patients in our center exhibited comparable or even superior patient survival and technical survival rates, compared with reports from other centers in China and other countries.

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Impact of Pre-Dialysis Care on Clinical Outcomes in Peritoneal Dialysis Patients

American Journal of Nephrology ◽

10.1159/000444401 ◽

2016 ◽

Vol 43 (2) ◽

pp. 104-111 ◽

Cited By ~ 5

Author(s):

Dandara N. Spigolon ◽

Thyago P. de Moraes ◽

Ana E. Figueiredo ◽

Ana Paula Modesto ◽

Pasqual Barretti ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Proportional Hazards ◽

Patient Survival ◽

Serum Levels ◽

Cox Proportional Hazards ◽

Care Group ◽

Technique Survival ◽

Cox Proportional Hazards Models ◽

The Impact

Background: Structured pre-dialysis care is associated with an increase in peritoneal dialysis (PD) utilization, but not with peritonitis risk, technical and patient survival. This study aimed at analyzing the impact of pre-dialysis care on these outcomes. Methods: All incident patients starting PD between 2004 and 2011 in a Brazilian prospective cohort were included in this analysis. Patients were divided into 2 groups: early pre-dialysis care (90 days of follow-up by a nephrology team); and late pre-dialysis care (absent or less than 90 days follow-up). The socio-demographic, clinical and biochemical characteristics between the 2 groups were compared. Risk factors for the time to the first peritonitis episode, technique failure and mortality based on Cox proportional hazards models. Results: Four thousand one hundred seven patients were included. Patients with early pre-dialysis care presented differences in gender (female - 47.0 vs. 51.1%, p = 0.01); race (white - 63.8 vs. 71.7%, p < 0.01); education (<4 years - 61.9 vs. 71.0%, p < 0.01), respectively, compared to late care. Patients with early pre-dialysis care presented a higher prevalence of comorbidities, lower levels of creatinine, phosphorus, and glucose with a significantly better control of hemoglobin and potassium serum levels. There was no impact of pre-dialysis care on peritonitis rates (hazard ratio (HR) 0.88; 95% CI 0.77-1.01) and technique survival (HR 1.12; 95% CI 0.92-1.36). Patient survival (HR 1.20; 95% CI 1.03-1.41) was better in the early pre-dialysis care group. Conclusion: Earlier pre-dialysis care was associated with improved patient survival, but did not influence time to the first peritonitis nor technique survival in this national PD cohort.

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Serum albumin in patients on continuous ambulatory peritoneal dialysis--predictors and correlations with outcomes.

Journal of the American Society of Nephrology ◽

10.1681/asn.v381501 ◽

1993 ◽

Vol 3 (8) ◽

pp. 1501-1507 ◽

Cited By ~ 1

Author(s):

P G Blake ◽

G Flowerdew ◽

R M Blake ◽

D G Oreopoulos

Keyword(s):

Peritoneal Dialysis ◽

Serum Albumin ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Morbidity And Mortality ◽

Stepwise Multiple Regression ◽

Technique Survival ◽

Patient Morbidity ◽

Technique Failure

Serum albumin (SA) is a powerful predictor of patient morbidity and mortality in hemodialysis, but data are limited for continuous ambulatory peritoneal dialysis (CAPD). SA was monitored in 76 new CAPD patients over 222 6-month periods and mean SA was correlated with morbidity and mortality during those periods. The influence of initial SA on duration of technique survival was also investigated. To determine which factors best predict SA, correlations with patient demographics and with 6-month measurements of dialytic dose, protein intake, and peritoneal transport were sought. Mean SA overall was 34.1 +/- 3.3 g/L, and mean initial SA was 33.4 +/- 3.1 g/L. Mean SA was lower in diabetics and in those aged 65 or over. Mean SA tended to increase during the first year on CAPD, and this increase was maintained, except in patients aged 65 or over, where it tended to revert to initial values. SA correlated with hospital days (r = -0.20; P < 0.005), fatigue index (r = -0.20; P < 0.005), nerve conduction (P < 0.001), and a variety of laboratory values, and lower SA was associated with technique failure (P < 0.03) and death (P < 0.07). Initial, as well as ongoing, SA was predictive of technique failure (P < 0.05) and Cox proportional hazards regression showed that this predictive power was independent of age, sex, diabetes, and other factors (P = 0.05). The strongest predictors of low SA by stepwise multiple regression were diabetes, a higher dialysate-to-plasma creatinine equilibration ratio, older age, lower body weight, and shorter time on CAPD.(ABSTRACT TRUNCATED AT 250 WORDS)

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The impact of palliative resection (PR) of the primary tumor on overall survival (OS) in metastatic colorectal cancer (mCRC).

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.509 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 509-509

Author(s):

Gillian Gresham ◽

Daniel John Renouf ◽

Matthew Chan ◽

Winson Y. Cheung

Keyword(s):

Propensity Score ◽

Primary Tumor ◽

Proportional Hazards ◽

Early Stage ◽

Significant Proportion ◽

Population Based ◽

Cox Proportional Hazards ◽

Entire Cohort ◽

Cox Proportional Hazards Models ◽

The Impact

509 Background: The role of PR of the primary tumor in mCRC remains unclear. Using population-based data, we explored the impact of PR on OS. Methods: Patients (pts) with mCRC who were referred to 1 of 5 regional cancer centers in British Columbia between 2006 and 2008 were reviewed (n=802). Pts with prior early stage CRC who relapsed with mCRC were excluded (n=285). We conducted survival analysis using Kaplan Meier methods and determined adjusted hazard ratios (HR) for death using Cox proportional hazards models. A secondary propensity score matched analysis was performed to control for baseline differences between pts who underwent PR and those who did not. Results: A total of 517 pts with mCRC were identified: median age was 63 years (range 23-93), 54% were men, 55% had ECOG 0-1, 76% had a colon primary, and 31% had >1 metastatic site. The majority (n=378; 73%) underwent PR of the primary tumor and a significant proportion (n=327; 63%) received palliative chemotherapy (CT). Compared to pts without PR, those with PR were more likely to be men (62 vs 51%, p=0.03), aged <65 years (63 vs 52%, p=0.03), ECOG 0-1 (61 vs 38%, p<0.0001), and receive palliative CT (68 vs 50%, p=0.0004). PR was associated with improved median OS across groups (Table). The benefit of PR on prognosis persisted in multivariate analysis (HR for death 0.56, 95%CI 0.43-0.72, p<0.0001 for entire cohort; HR 0.51, 95%CI 0.37-0.70, p<0.0001 for individuals who were treated with CT; and HR 0.54, 95%CI 0.34-0.84, p=0.007 for those who did not receive CT). In a propensity score matched analysis that considered age, gender, ECOG, and receipt of palliative CT, prognosis continued to be more favorable in the PR group (HR 0.66, 95% CI 0.50-0.86, p=0.0019). Conclusions: In this population-based analysis, PR of the primary tumor in mCRC was associated with a significant OS benefit. [Table: see text]

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Out-of-Sequence Vaccinations With Measles Vaccine and Diphtheria-Tetanus-Pertussis Vaccine: A Reanalysis of Demographic Surveillance Data From Rural Bangladesh

Clinical Infectious Diseases ◽

10.1093/cid/ciaa291 ◽

2020 ◽

Cited By ~ 1

Author(s):

Clara Clipet-Jensen ◽

Andreas Andersen ◽

Aksel Karl Georg Jensen ◽

Peter Aaby ◽

K Zaman

Keyword(s):

Mortality Rate ◽

Proportional Hazards ◽

Child Survival ◽

Oral Polio Vaccine ◽

Cox Proportional Hazards ◽

Measles Vaccine ◽

Negative Effects ◽

Cox Proportional Hazards Models ◽

The Difference ◽

Mortality Rate Ratio

Abstract Background Due to delays in vaccinations, diphtheria-tetanus-whole-cell-pertussis (DTP) is often given with or after measles vaccine (MV)—out of sequence. We reanalyzed data from Matlab, Bangladesh, to examine how administration of MV and DTP out-of-sequence was associated with child survival. Methods In sum, 36 650 children born between 1986 and 1999 were followed with registration of vaccinations and survival. Controlling for background factors using Cox proportional hazards models, survival was analyzed between 9 and 24 months of age. We measured the mortality rate ratio (MRR) to compare vaccination groups. Oral polio vaccine (OPV) campaigns, which started in 1995, reduced the mortality rate and reduced the difference between vaccination groups. In the main analysis, we therefore censored for OPV campaigns; there were 151 nonaccident deaths before the OPV campaigns. Results Compared with MV administered alone (MV-only), DTP administered with or after MV had MRR 2.20 (1.31–3.70), and DTP-only had MRR 1.78 (1.01–3.11). Compared with MV-only, DTP administered with MV had a female-male MRR 0.56 (0.13–2.38), significantly different to DTP administered after MV, which had MRR 14.83 (1.88–117.1), test of interaction P = .011. Compared with having DTP (no MV) as most recent vaccination, MV-only had a nonaccident MRR of 0.56 (0.32–0.99). Conclusion The negative effects of non-live DTP with or after live MV are not explained merely by selection bias. These observations support a live-vaccine-last policy where DTP should not be given with or after MV.

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Pre-ESRD Dementia and Post-ESRD Mortality in a Large Cohort of Incident Dialysis Patients

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000471761 ◽

2017 ◽

Vol 43 (5-6) ◽

pp. 281-293 ◽

Cited By ~ 5

Author(s):

Miklos Z. Molnar ◽

Keiichi Sumida ◽

Abduzhappar Gaipov ◽

Praveen K. Potukuchi ◽

Tibor Fülöp ◽

...

Keyword(s):

Mortality Rate ◽

Proportional Hazards ◽

International Classification Of Diseases ◽

Cox Proportional Hazards ◽

Dialysis Initiation ◽

Entire Cohort ◽

Cox Proportional Hazards Models ◽

Increased Risk ◽

All Cause Mortality ◽

Stage Renal Disease

Background: Conservative management may be a desirable option for elderly, fragile, or demented patients who reach end-stage renal disease (ESRD), yet some patients with dementia are placed on renal replacement therapy nonetheless. Methods: From a nationwide cohort of 45,076 US veterans who transitioned to ESRD over 4 contemporary years (October 1, 2007 to September 30, 2011), we identified 1,336 (3.0%) patients with International Classification of Diseases, Ninth Revision, Clinical Modification code-based dementia diagnosis during the prelude (predialysis) period. We examined the association of prelude dementia with all-cause mortality within the first 6 months following transition to dialysis, using a propensity-matched cohort and Cox proportional hazards models. Results: In the entire cohort, the overall mean ± standard deviation age at baseline was 72 ± 11 years, 95% were male, 23% were African-American, and 66% were diabetic. There were 8,080 (18.5%) deaths (mortality rate, 412; 95% confidence interval [CI], 403-421/1,000 patient-years) in the dementia-negative group, and 396 (29.6%) deaths (mortality rate, 708; 95% CI, 642-782/1,000 patient-years) in the dementia-positive group in the entire cohort in the first 6 months after dialysis initiation. Presence of dementia was associated with higher risk of all-cause mortality (adjusted hazard ratio, 1.25; 95% CI, 1.12-1.38) compared to dementia-free patients in the first 6 months after dialysis initiation. Conclusion: Pre-ESRD dementia is associated with increased risk of early post-ESRD mortality in veterans transitioning to dialysis.

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Effect of Sedative-Hypnotic Medicines on Mortality in Peritoneal Dialysis Patients with Sleep Disorders: A Retrospective Cohort Study

Blood Purification ◽

10.1159/000484922 ◽

2017 ◽

Vol 45 (1-3) ◽

pp. 95-101

Author(s):

Ying Zhou ◽

Peiran Yin ◽

Bin Li ◽

Jianying Li ◽

Naya Huang ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Sleep Disorders ◽

Older Patients ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Dialysis Patients ◽

Factors Associated ◽

Cox Proportional Hazards Models ◽

Hypnotic Medication ◽

All Cause Mortality

Background: Sedative-hypnotic medication is widely used among continuous ambulatory peritoneal dialysis (CAPD) patients with sleep disorders; however, its effect on mortality has rarely been investigated. Methods: Logistic regression was employed to identify factors associated with sedative-hypnotic medication, whose effect on mortality was evaluated by Cox proportional hazards models. Results: A total of 146 CAPD patients with sleep disorders were recruited, of which 46 patients (31.5%) used either benzodiazepines or zolpidem. Sedative-hypnotic medication was more frequently used by older patients and those with longer duration of CAPD therapy and there was no significant association between sedative-hypnotic medicines and all-cause mortality after adjusting for age, gender, diabetes, cardiovascular disease, and duration of CAPD. Conclusion: Sedative-hypnotic medication was more often used by older patients and patients with a longer duration of CAPD. There was no association between these agents and all-cause mortality in CAPD patients with sleep disorders.

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