Predictors of Death in Patients on Peritoneal Dialysis: The Missouri Peritoneal Dialysis Study

Abstract

Background: The study was designed to identify predictors of death in subjects on peritoneal dialysis (PD). Methods: The population consisted of patients initiated on PD at the University of Missouri-Columbia and Dialysis Clinic Incorporated from January 1, 1990, through December 31, 1999. Baseline variables included demographics, clinical data, initial measures of nutritional status, adequacy, and transport characteristics. Co-morbidities were scored using a modified version of the Index of Coexistent Disease. Ongoing (during the course of PD) variables consisted of clinical characteristics and weighted time average of a number of laboratory, adequacy, and nutritional variables. The variables were screened using a univariate procedure, and then analyzed using stepwise logistic regression to evaluate their independent relation to death. Results: There were 105 men and 86 women – 180 Caucasians, 10 African-American, 1 Asian, mean age 61 ± 13 (SD) years, and mean duration of follow-up 21 ± 18 months. Eighty-two patients suffered the outcome of death. Lean body mass (LBM) at the initiation of PD was negatively associated with the risk of death (p < 0.01). In addition, the need for a partner to perform PD, total morbidity count, and the summated severity score of all co-morbidities were associated with an increased risk of death. The analysis of ongoing variables revealed that serum phosphate (negative association, p = 0.02) and number of hospitalization days per month on PD (p = 0.0006) were associated with an increased risk of death. Conclusion: Phosphate levels and LBM are strong negative predictors of death in PD subjects. Further, patients who need the assistance of a partner to perform PD have decreased survival.

Predictors of Hospitalization in Patients on Peritoneal Dialysis: The Missouri Experience

“…This could also mean that patients who cannot take care of themselves may not get the best possible care from their caregiver for various reasons. We have previously demonstrated that the need for partner to perform PD was associated with an increased risk of mortality in PD subjects [5]. A previous study also found that the need for a helper to perform PD was independently associated with increased hospitalization [10].…”

“…The methods of the current study have been previously described in detail [5]. Briefly, data for each subject was derived from detailed review of on-site medical records, including the computerized Medical Information System.…”

“…Further, abdominal hernia was included as a variable both in a categorical manner (present or absent) and also based on a severity scale, which primarily takes into account when the hernia occurred in relation to the initiation of PD. The details of the scoring system have been published previously [5]. …”

Novel Equations for Estimating Lean Body Mass in Peritoneal Dialysis Patients

“…Additionally, we assessed the prognostic values of LBM in all-cause mortality risk in a large retrospective PD cohort study because LBM should be a significant predictor of outcome events in PD patients (3,(8)(9)(10).…”

Clinical Research in a Modern Chinese Peritoneal Dialysis Center

“…A second example concerns lean body mass (LBM), which is considered an index of muscle protein store and a biomarker for overall outcome in dialysis patients (12)(13)(14). The "gold standard" for LBM measurement is the tracer dilution method (15), which is laborious, invasive, and not suitable for routine patient care.…”