Predictors of Survival in Continuous Ambulatory Peritoneal Dialysis Patients: A Five-Year Prospective Study

Avram, Morrell M.; Fein, Paul A.; Bonomini, Luigi; Mittman, Neal; Loutoby, Raphael; Avram, David K.; Chattopadhyay, Jyotiprakas

doi:10.1177/089686089601601s36

Cited by 46 publications

(24 citation statements)

References 15 publications

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“…The serum creatinine level is valid and a clinically useful marker of protein-energy nutritional status in maintenance dialysis patients. The serum creatinine level reflecting the nutritional status is inversely related to mortality in patients with PD (26)(27)(28)(29)(30)(31). In our study, patients with higher creatinine levels at the beginning of treatment and during the follow-up period had higher survival rates similar to the results of Sipahioglu et al's (10) and Ates et al's (22) studies from Turkey.…”

Section: Dıscussıonsupporting

confidence: 87%

Clinical Outcomes of Peritoneal Dialysis Patients at a Secondary State Hospital Nephrology Clinic

Sarı¹,

Sarıkaya²,

Çetinkaya³

et al. 2012

Turk Neph Dial Transpl

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OBJECTIVE: We present our experience with demographics, clinical and biochemical outcomes, and factors affecting mortality in ESRD patients treated with peritoneal dialysis (PD) during a 12-year period (1997–2009) at secondary state hospital's nephrology clinic.MATERIAL and METHODS: After excluding patients younger than age 15 at the initiation of PD, those who had follow-ups at less than three months, outcomes were analyzed for 313 patients. The demographic, clinical, and biochemical data were collected from the patients' medical records.RESULTS: The mean age at the start of PD was 51.9 ± 17.6 years and the mean PD duration was 27.5 ± 27.1 months (median: 20, range: 3–166). Hypertension was the most common cause of ESRD (36.1%), followed by diabetes mellitus (31.3%). Among these 313 patients, 58 (18.5%) died. Patients' survival rates were 93.3%, 85%, and 72.4%, at one, three, and five years, respectively. A higher educational level (p=0.045), lower age (p=0.002), higher baseline creatinine (p=0.045), and higher baseline albumin level (p=0.003) were found to affect patients' survival. Technique survival rates were 89.1%, 84%, and 74.1% at one, three and five years, respectively. Technique failure was associated with peritonitis rate (p=0.03).CONCLUSION: Our results suggest that patients' and technique survival rates and the factors affecting mortality in our patients at a secondary state hospital's nephrology clinic were similar to those at a tertiary care university hospital's nephrology clinic in Turkey

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Section: Dıscussıonsupporting

confidence: 87%

Clinical Outcomes of Peritoneal Dialysis Patients at a Secondary State Hospital Nephrology Clinic

Sarı¹,

Sarıkaya²,

Çetinkaya³

et al. 2012

Turk Neph Dial Transpl

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“…It is now accepted that chronic inflammation [4][5][6][7][8][9]36 and malnutrition [10][11][12]37 are important contributors to morbidity and mortality of CVD in renal dialysis patients, meanwhile, the inflammatory [14][15][16][17] and nutrient biomarkers 11,18,19 are useful predictors. The objective of this systematic review was to examine whether statins had an effect on chronic inflammation and nutrition status in renal dialysis patients.…”

Section: Discussionmentioning

confidence: 99%

“…Since the studies of Kushner, who demonstrated the deposition of CRP in experimental myocardial infarction, 13 many studies have shown the relationship between inflammatory markers and CVD 14–17 . There are several studies that have shown that a low serum albumin level is an independent predictor of total and cardiovascular mortality in haemodialysis (HD) 11 and peritoneal dialysis (PD) 18 patients. A significant inverse relation between serum albumin and all‐cause and cardiovascular mortalities was shown in a meta‐analysis 19 .…”

Section: Introductionmentioning

confidence: 99%

Effect of statins on chronic inflammation and nutrition status in renal dialysis patients: A systematic review and meta‐analysis

Deng

Liao

et al. 2012

Nephrology

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: Aim: 3‐hydroxy‐3‐methylglutaryl coenzyme A (HMG‐CoA) reductase inhibitors (statins) may have an adjunctive effect on chronic inflammation and nutrition status in renal dialysis patients. Therefore, we performed a systematic review of randomized controlled trials to assess the effect of statins on chronic inflammation and nutrition status in dialysis patients. Methods: The randomized controlled trials (RCTs) of statins versus placebo or no treatment for renal dialysis patients were searched from PubMed, EMbase and Cochran Central Register of Controlled Trials. We screened relevant studies according to predefined inclusion and exclusion criteria, evaluated the quality of the included studies, and performed meta‐analyses by using the Cochrane Collaboration's Revman 5.1 software. Results: We identified nine trials including 3098 patients. Meta‐analysis showed statins can significantly decrease the serum C‐reactive protein (CRP) (SMD, −0.54; 95% confidence interval (CI), −1.04 to −0.05; P = 0.03) and high sensitivity CRP (hs‐CRP) level (SMD, −0.72; 95% CI, −1.14 to −0.31; P = 0.0007) of dialysis patients compared with that of the control group. However, statins did not differ significantly from the control group in increasing the serum Alb level (SMD, −0.13; 95% CI, −0.42 to 0.15; P = 0.37). Conclusions: Statins can improve the chronic inflammation status reflected by the decreasing of serum CRP and hs‐CRP levels, whereas there is no conclusive evidence that it can improve the nutrition status. However, this result needs to be further confirmed in more high‐quality randomized clinical trials.

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“…Since both inflammation and inadequate nutritional intake may decrease the concentration of commonly used biochemical markers of malnutrition (35), much of the previously reported relationship between serum albumin and mortality in both HD (36) and PD (37) patients may have been caused by an inflammatory process rather than poor nutritional intake. Indeed, since the first report by Bergström et al (38) of an association between an elevated CRP level and increased mortality, several groups have reported similar findings in both HD (39,40) and PD (41) patients.…”

Section: Markers Of Inflammation Is a Strong Predictor Of Outcomementioning

confidence: 99%

Review Articles: Inflammation in End‐stage Renal Disease: Sources, Consequences, and Therapy

Stenvinkel

Alvestrand

2002

Seminars in Dialysis

371

284

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Cardiovascular disease (CVD) remains the main cause of morbidity and mortality in patients with end-stage renal disease (ESRD). Although traditional risk factors are common in ESRD patients, they alone may not be sufficient to account for the high prevalence of CVD in this condition. Recent evidence demonstrates that chronic inflammation, a nontraditional risk factor which is commonly observed in ESRD patients, may cause malnutrition and progressive atherosclerotic CVD by several pathogenetic mechanisms. The causes of inflammation in ESRD are multifactorial and, while it may reflect underlying CVD, an acute-phase reaction may also be a direct cause of vascular injury by several pathogenetic mechanisms. Available data suggest that proinflammatory cytokines play a central role in the genesis of both malnutrition and CVD in ESRD. Thus it could be speculated that suppression of the vicious cycle of malnutrition, inflammation, and atherosclerosis (MIA syndrome) would improve survival in dialysis patients. Recent evidence has demonstrated strong associations between inflammation and both increased oxidative stress and endothelial dysfunction in ESRD patients. As there is not yet any recognized, or even proposed, treatment for ESRD patients with chronic inflammation, it would be of obvious interest to study the long-term effect of various anti-inflammatory treatment strategies on the nutritional and cardiovascular status as well as outcome in these patients.

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Predictors of Survival in Continuous Ambulatory Peritoneal Dialysis Patients: A Five-Year Prospective Study

Cited by 46 publications

References 15 publications

Clinical Outcomes of Peritoneal Dialysis Patients at a Secondary State Hospital Nephrology Clinic

Clinical Outcomes of Peritoneal Dialysis Patients at a Secondary State Hospital Nephrology Clinic

Effect of statins on chronic inflammation and nutrition status in renal dialysis patients: A systematic review and meta‐analysis

Review Articles: Inflammation in End‐stage Renal Disease: Sources, Consequences, and Therapy

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