Effects of Erythropoietin Payment Policy on Cardiovascular Outcomes of Peritoneal Dialysis Patients: Observational Study (Preprint)

Abstract

UNSTRUCTURED Background and Purposes: The change in reimbursement policy of erythropoietin application to peritoneal dialysis (PD) patients by Taiwan National Health Insurance (NHI) system provided a natural experimental venue to examine whether cardiovascular risk differs while keeping hematocrit (Hct) below 30% or over 30%. This study intended to analyze the impact of loosening erythropoietin payment criteria for PD patients on their cardiovascular outcomes. Methods: Two cohorts of incident PD patients before and after the relaxation of NHI’s erythropoietin payment criteria were identified as Cohort 1 and Cohort 2, respectively, and further matched by propensity scores and then followed up for cardiovascular events. There were 1,759 patients in Cohort 1 and 2,981 patients in Cohort 2. After propensity score matching, 1,754 subjects were selected from each cohort. The outcome measures were cardiovascular events and were analyzed through Cox regressions. Findings and Conclusion: For the composite cardiovascular endpoint, Cohort 2 patients had significantly lower risk than Cohort 1. The risk reduction was observed only in diabetic patients. After loosening erythropoietin payment criteria, less cardiovascular risks were observed, particularly for diabetic patients. It is concluded that for diabetic PD patients, maintaining a Hct level higher than 30% is crucial for reducing the cardiovascular risk.

Damping and polarization rates in near equilibrium state

“…To calculate the polarization rate ω sµ , we substitute the equilibrium solutions (36) into (35). There are still three channels allowed by energy-momentum conservation.…”

“…Based on the framework developed in Ref. [32], the spin-diffusion term for massive quarks is calculated up to the leading logarithmic order [32], a new polarization direction is discovered in an off-equilibrium and weakly coupled electrodynamics plasma [35], and the global equilibrium spin distribution function is obtained through detailed balance principle [36].…”

Spin Polarization Induced by Inhomogeneous Dynamical Condensate

“…The chiral kinetic theory [18][19][20][21][22][23][24][25][26][27] is developed to describe the anomalous transport of massless fermions, and is further extended to the spin transport theory of massive fermions [28][29][30][31][32]. Recently, based on the Keldysh theory, it is extended from the free streaming scenario to the collisional effects [33][34][35][36][37][38][39]. In the researches above, the mass of fermion is taken to be zero (chiral limit) or a finite constant.…”

Local Equilibrium Spin Distribution From Detailed Balance

“…The chiral kinetic theory [22][23][24][25][26][27][28][29][30][31] is developed to describe the anomalous transport of massless fermions, and is further extended to the spin transport theory of massive fermions [32][33][34][35][36]. Recently, it is extended from the free streaming scenario to discussing the collisional effects [37][38][39][40][41]. The general framework of spin transport with collision terms is derived based on the Keldysh theory [37].…”

“…This framework is then applied to the weakly coupled quark-gluon plasma at high temperature to compute the spin-diffusion term for massive quarks up to the leading logarithmic order [37] and weakly coupled quantum electrodynamics plasma in Ref. [41]. In this work, we investigate the collision term in spin transport theory based on the framework in Ref.…”