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

Abstract

Background: We analyzed a large number of demographic and biochemical variables to identify predictors of hospitalization in subjects on peritoneal dialysis (PD). Methods: All patients initiated on PD at our center from January 1990 through December 1999 were included. The following variables at the initiation of PD were included: demographics, clinical data, nutritional and adequacy parameters, transport characteristics, and various co-morbidities. Co-morbidities were graded for severity using a modified version of the Index of Coexistent Disease. Variables included during the course of PD consisted of weighted time average of a number of laboratory, adequacy, and nutritional parameters along with the number of peritonitis episodes per year. Stepwise linear regression was used following a univariate screening procedure to identify independent predictors of the outcome of hospitalization days per month on PD. Results: The subject population consisted of 191 subjects (105 men, 86 women; 180 Caucasians, 10 African-American, 1 Asian). The mean age was 61 ± 13 (SD) years and mean duration of follow-up was 21 ± 18 months. The baseline variable analysis revealed that the presence of partner to perform PD predicted increased hospitalization (p < 0.0001). Additionally, the presence and severity of peripheral vascular disease and residual renal Kt/V at baseline (negative association) predicted increased hospitalization. In the analyses of ongoing variables, stepwise linear regression solely identified weighted time average albumin as a strong negative predictor of hospitalization (p < 0.0001). Conclusion: A comprehensive analysis of a large number of variables revealed that serum albumin during the course of PD (negative association) and the need for partner to perform PD strongly predicted increased hospitalization in PD subjects.

Peritoneal dialysis-associated peritonitis: clinical features and predictors of outcome

“…16 In addition, low serum albumin predicts both mortality and prolonged hospital stay in patients with PD-associated peritonitis. 17 However, in our study, even though low serum albumin was associated more frequently with a complicated course on univariate analysis, it was not independently associated with a complicated course on multivariate analysis, as has been reported by others. 10 Since long-term chronic PD therapy has been associated with alterations in peritoneal membrane structure and peritoneal macrophage function, it was thought that the duration of PD treatment might be a predictor of a complicated course, although data are inconclusive.…”

Impact of Early Nephrology Referral on Mortality and Hospitalization in Peritoneal Dialysis Patients

“…Furthermore, because our study captured information on incident PD patients from a single center with a special interest in PD, further work will be needed to determine generalizability to populations of other ethnicities and geographic regions. For instance, in spite of a case-mix similar to most PD cohorts, the median hospitalization rate below 10 days per patient-year at risk among our subjects is less than the national average in the United States (22,23). Finally, the disproportionately low number of mortality events limited the precision of the results obtained.…”

Arterial Pulse Wave Velocity and Peritoneal Transport Characteristics Independently Predict Hospitalization in Chinese Peritoneal Dialysis Patients

“…We found that C-F PWV and D/P creatinine are independent predictors of hospitalization for CVD. A previous study (38) showed transport characteristic is not a predictor of hospitalization. To the best of our knowledge, this is the first study to show that C-F PWV and D/P creatinine are predictors of hospitalization for CVD at the same time.…”