Effects of AA Amyloidosis on Survival in Peritoneal Dialysis

Abstract

Background: To investigate the effects of ESRD etiologies on mortality in peritoneal dialysis patients. Methods: We included patients who initiated therapy between 2001-2011 and classified them according to etiologies including amyloidosis, diabetes mellitus, chronic glomerulonephritis and polycistic renal disease. Socio-demographic data, clinical courses and infectious complications were compared between groups, and the reasons for peritoneal dialysis withdrawal were recorded. Patient and technique survival analysis were performed. Results: 354 patients were included to the study. Thereafter, 154 patients were excluded. Totally, 29 patients with AA-amyloidosis (mean age 37.9±16.4 years, follow-up time 21.7±20.2 months), 78 patients with diabetes mellitus (mean age 56.9±13.6 years, follow-up time 35±28.6 months), 68 patients with chronic glomerulonephritis (mean age 37.2±12 years, follow-up time 47.7±29.9 months), 29 patients with polycystic renal disease (mean age 35.6±13.8 years, follow-up time 45.4±36.8 months) were evaluated. Albumin level was lower in patients with amyloidosis at initiation and the end of study (for both p<0.001). Incidence of peritonitis and catheter exit site/tunnel infection attacks were higher in patients with amyloidosis (p=0.002 and 0.018 respectively). There was statistical difference among groups with respect to the last status of patients (p<0.001). Deaths were frequent in amyloidotic and diabetic patients. The majority of deaths were due to peritonitis and/or sepsis and, cardiovascular reasons. The mortality rate was found higher in patients with amyloidosis (log rank=0.005), especially at first 2-3 years. Presence of anyone helping to administer peritoneal dialysis(OR:6.244, p=0,025), initial serum albumin level(OR:0.352, p=0,034) and presence of catheter exit site/tunnel infection(OR:0.250, p=0,015) were independent predictors of patient survival. Conclusion: Renal failure etiology has effects on peritoneal dialysis patients’ survival. Patients with amyloidosis have the worst survival. Because of loss of PD survival advantage seen in first years of therapy in patients with amyloidosis, peritoneal dialysis may not be suitable as first choice therapy in this group.

The spectrum of urological disease in familial Mediterranean fever: amyloidosis and beyond

“…33,35 Decreased endothelial flow mediated diameter and increased carotid intima media thickness were proved in FMF patients, increasing the burden on kidneys. 36,37 On the other hand, renal amyloidosis was found to worsen the cardiovascular risk in FMF patients 38,39 and responsible for the worst prognosis among other etiologies of renal affection as regards the response to peritoneal dialysis 40 and posttransplantation morbidity and mortality. 41 Predictors of renal and/or urological affection in patients with FMF.…”

Peritoneal Dialysis Failure and its Impact on Holistic Kidney Care: A Case Report

“…In such patients, a significant correlation was found between the serum albumin level and mortality (Zakharova, 2015); therefore, hypoalbuminemia in patients with amyloidosis can predict an increased risk of patient death (Ahbap et al, 2014). Further, Koc et al’s (2012) study demonstrated that catheter exit-site/tunnel infection was one of the significant and independent predictors of the survival rates of patients with amyloidosis.…”

“…Research has shown that patients with amyloidosis are significantly more likely to develop peritonitis ( p = .002) and catheter exit-site/tunnel infection ( p = .018) compared to patients with other etiologies of ESRF, including diabetes mellitus, chronic glomerulonephritis, and polycystic kidney disease (Koc et al, 2012). Catheter exit-site/tunnel infection has been reported as an independent predictor for patient survival (odds ratio: 0.250, p = .015) (Koc et al, 2012).…”

“…There is little research available from the last 20 years related to holistic nursing management of CAPD-associated peritonitis in patients with amyloidosis. Nevertheless, this is an important issue because studies have shown an association between patient survival rate and occurrence of catheter exit-site/tunnel infection and peritonitis in such patients (Koc et al, 2012).…”

“…Research has shown that patients with amyloidosis are significantly more likely to develop peritonitis ( p = .002) and catheter exit-site/tunnel infection ( p = .018) compared to patients with other etiologies of ESRF, including diabetes mellitus, chronic glomerulonephritis, and polycystic kidney disease (Koc et al, 2012). Catheter exit-site/tunnel infection has been reported as an independent predictor for patient survival (odds ratio: 0.250, p = .015) (Koc et al, 2012). In such patients, a significant correlation was found between the serum albumin level and mortality (Zakharova, 2015); therefore, hypoalbuminemia in patients with amyloidosis can predict an increased risk of patient death (Ahbap et al, 2014).…”