Confounding Effect of Comorbidities and Malnutrition on Survival of Peritoneal Dialysis Patients

Prasad, Narayan; Gupta, Amit; Sinha, Archana; Sharma, Raj Kumar; Saxena, Anita; Kaul, Anupama; Bhaduria, Dharmender; Gupta, Anurag

doi:10.1053/j.jrn.2010.01.001

Cited by 27 publications

(21 citation statements)

References 19 publications

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“…Protein energy wasting is commonly encountered in peritoneal dialysis patients, and associated with increased morbidity and mortality [2,19]. As such, reliable assessment of nutritional status is an important tool in routine clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…The increased risk of mortality associated with protein energy wasting is often confounded by the association between increasing co-morbidity, both physical and psychological, and poor nutrition [2]. As there is currently no gold standard measurement for determining protein energy wasting, the K/DOQI guidelines recommended a combination of methods and assessments [1], including serum albumin measurement, calculation of creatinine generation rate [3], dietary diaries and interviews, subjective global assessment (SGA), anthropometric assessment [4], comparison with an estimation of ideal body weight, dual-energy X-ray absorptiometry (DEXA) scanning and bioimpedance.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Body Composition in Peritoneal Dialysis Patients Using Bioelectrical Impedance and Dual-Energy X-Ray Absorptiometry

Fürstenberg

Davenport²

2011

Am J Nephrol

130

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Introduction: Protein energy wasting is closely related to increased morbidity and mortality in peritoneal dialysis (PD) patients. Simple reliable and easily available methods of determining nutritional status and recognition of short-term changes in body composition are therefore important for clinical practice. Methods: We compared whole-body and segmental composition using multifrequency bioelectrical impedance analysis (MF-BIA) and dual-energy X-ray absorptiometry (DEXA) in 104 stable PD patients. Results: Assessment of whole-body composition showed that lean body mass (LBM) was highly correlated with good method agreement using DEXA as the reference test (r = 0.95, p < 0.0001; bias –0.88 kg, 95% CI –1.53 to 0.23 kg). Similarly, high correlation and good method agreement were found for fat mass (r = 0.93, p < 0.0001; bias 0.69 kg, 95% CI 0.03–1.36 kg). Segmental analysis of LBM revealed strong correlations between LBM for trunk, left and right arms and legs (r = 0.90, 0.84, 0.86, 0.89 and 0.90, respectively, p < 0.0001). Bone mineral content derived by MF-BIA overestimated that measured by DEXA (bias 0.740 kg, 95% CI 0.66–0.82 kg). Conclusion: MF-BIA may potentially be a useful tool for determining nutritional status in PD patients and serial estimations may help recognize short-term changes in body composition.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessment of Body Composition in Peritoneal Dialysis Patients Using Bioelectrical Impedance and Dual-Energy X-Ray Absorptiometry

Fürstenberg

Davenport²

2011

Am J Nephrol

130

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“…It is well known that the common causes of death in PD patients are cardiovascular disease, 10 chronic inflammation, 11 malnutrition, 12 and peritonitis. 13 The aim of this research was to study the association between BMI and mortality and to evaluate these risk factors in the PD population according to BMI.…”

Section: Introductionmentioning

confidence: 99%

Survival Advantage of Normal Weight in Peritoneal Dialysis Patients

et al. 2011

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Introduction: A high body mass index (BMI) is a positive predictor of outcome in hemodialysis. But reports for peritoneal dialysis (PD) have been less numerous. The aim of the present investigation was to study the association between BMI and survival among PD patients and to discuss the main risk factors affecting survival. Materials and methods: A total of 159 patients who received PD from 1 January 2006 to 31 December 2010 at the Department of Nephrology in the Third Affiliated Hospital of Soochow University were enrolled in the study. Blood samples and baseline characteristics of the study cohort were obtained at the start of PD. Patient survival status was recorded through 31 December 2010. Results: Patients were stratified into two groups as normal weight (BMI, 18.5-24.9) and overweight (BMI, 25.0-29.9). KaplanMeier survival curve revealed that the normal weight patients had survival advantage over overweight patients (p < 0.01, by log-rank test). Cox proportional hazard models revealed that BMI, age, diabetes mellitus, coronary vascular disease, congestive heart failure and lipoprotein(a) (Lp(a)) were significant risk factors associated with all-cause mortality (p < 0.05). After adjustment for these covariates, survival was consistently higher for normal weight patients (p < 0.01). Furthermore, the study demonstrated that normal weight patients had lower serum Lp(a) (p < 0.05), C-reactive protein (CRP) (p < 0.05), and peritonitis rate (p < 0.05) compared with overweight patients. Conclusion: The results indicated that normal BMI at the commencement of PD had significant survival advantage in our study. The mechanisms for this might be related to lower cardiovascular risk, less chronic inflammation, and peritonitis prevalence.

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“…74 Estimates show that the prevalence of NCDs such as diabetes, hypertension, coronary artery disease, heart failure, obesity, chronic respiratory diseases, and various cancers continues to increase globally. The increase has been projected to be higher in LMICs where NCDs will account for 69% of disease burden in 2020, up from 47% in 1990.…”

Section: 73mentioning

confidence: 99%

Continuous ambulatory peritoneal dialysis: perspectives on patient selection in low- to middle-income countries

Wearne¹,

Kilonzo²,

Effa³

et al. 2017

IJNRD

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Abstract:Chronic kidney disease is a major public health problem that continues to show an unrelenting global increase in prevalence. The prevalence of chronic kidney disease has been predicted to grow the fastest in low-to middle-income countries (LMICs). There is evidence that people living in LMICs have the highest need for renal replacement therapy (RRT) despite the lowest access to various modalities of treatment. As continuous ambulatory peritoneal dialysis (CAPD) does not require advanced technologies, much infrastructure, or need for dialysis staff support, it should be an ideal form of RRT in LMICs, particularly for those living in remote areas. However, CAPD is scarcely available in many LMICs, and even where available, there are several hurdles to be confronted regarding patient selection for this modality. High cost of CAPD due to unavailability of fluids, low patient education and motivation, low remuneration for nephrologists, lack of expertise/experience for catheter insertion and management of complications, presence of associated comorbid diseases, and various socio-demographic factors contribute significantly toward reduced patient selection for CAPD. Cost of CAPD fluids seems to be a major constraint given that many countries do not have the capacity to manufacture fluids but instead rely heavily on fluids imported from developed countries. There is need to invest in fluid manufacturing (either nationally or regionally) in LMICs to improve uptake of patients treated with CAPD. Workforce training and retraining will be necessary to ensure that there is coordination of CAPD programs and increase the use of protocols designed to improve CAPD outcomes such as insertion of catheters, treatment of peritonitis, and treatment of complications associated with CAPD. Training of nephrology workforce in CAPD will increase workforce experience and make CAPD a more acceptable RRT modality with improved outcomes.

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Confounding Effect of Comorbidities and Malnutrition on Survival of Peritoneal Dialysis Patients

Cited by 27 publications

References 19 publications

Assessment of Body Composition in Peritoneal Dialysis Patients Using Bioelectrical Impedance and Dual-Energy X-Ray Absorptiometry

Assessment of Body Composition in Peritoneal Dialysis Patients Using Bioelectrical Impedance and Dual-Energy X-Ray Absorptiometry

Survival Advantage of Normal Weight in Peritoneal Dialysis Patients

Continuous ambulatory peritoneal dialysis: perspectives on patient selection in low- to middle-income countries

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