Quantifying comorbidity in peritoneal dialysis patients and its relationship to other predictors of survival

Davies, Simon

doi:10.1093/ndt/17.6.1085

Cited by 340 publications

(302 citation statements)

References 29 publications

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“…4,16,17 Patients on PD have received considerable attention due to the association of PD with a number of comorbidities, including viral hepatitis, coronary heart disease, DM, and HTN. Therefore, the comorbidity indexes as a predictor of mortality are more important than a single comorbidity.…”

Section: Discussionmentioning

confidence: 99%

“…At the initiation of PD, the comorbidities were graded by the Davies index. 4 The comorbidities by the Davies index were ischemic heart disease, peripheral vascular disease, left ventricular dysfunction, diabetes mellitus (DM), systemic collagen vascular disease, and other significant pathologies. As described previously, the Davies index was categorized as low risk (0), intermediate risk (1)(2), and high risk (≥3).…”

Section: Methodsmentioning

confidence: 99%

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Risk Factors for Mortality in Stable Peritoneal Dialysis Patients

et al. 2012

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Background: The mortality rates of end-stage renal disease patients have significantly declined over the past decade. However, there are few reports on the risk factors for mortality in stable peritoneal dialysis (PD) patients who survive for a considerable time. Patients and methods: We reviewed the medical records and identified all adult patients who received PD between April 2001 and March 2009 in our institution. The total cohort was 550 patients. Among these patients, 383 patients were enrolled as stable PD patients. Results: The cumulative survival of the stable PD patients was 91.6% at 3 years and 78.7% at 5 years. On univariate analysis, old age (≥65 years of age), hypoalbuminemia (<35 g/L), log C-reactive protein (CRP) (≥0.84), phosphorus (<1.13 mmol/L), statin, icodextrin, and the Davies index were associated with mortality for all PD patients. Old age, hypoalbuminemia, log CRP, phosphorus, the residual renal function (RRF) (≤4 mL/min/1.73 m 2 ) at 24 months, renin-angiotensin system blockade, icodextrin, and the Davies index were associated with mortality for the stable PD patients. Multivariate analysis showed that, among the variables, age, log CRP, phosphorus, initial RRF, and the Davies index were associated with mortality for all PD patients. In stable PD patients, age, log CRP, phosphorus, RRF at 24 months, and the Davies index were associated with mortality. Conclusion: Initial high RRF combined with the RRF preservation, maintenance of proper phosphorus, control of inflammation, and proper management of comorbidities may help to improve the survival of PD patients including stable PD patients.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Risk Factors for Mortality in Stable Peritoneal Dialysis Patients

et al. 2012

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“…Admission episodes with bacteremia and outcomes were also reviewed. The comorbidity score was calculated according to the method of Davies et al (11).…”

Section: Data Collectionmentioning

confidence: 99%

Bacteremia in Hemodialysis and Peritoneal Dialysis Patients

et al. 2012

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Objective To analyze the incidence rates and risk factors for bacteremia in patients undergoing hemodialysis (HD) and peritoneal dialysis (PD). Methods The records of 898 consecutive patients undergoing dialysis from January 2003 to December 2008 were reviewed retrospectively. Episodes of bacteremia were recorded. China Medical University (Taichung, Taiwan). Results The overall incidence rate of bacteremia was 7.63 per 100 patient-years in HD patients and 3.56 per 100 patient-years in PD patients and it was higher in HD patients each year from 2003 to 2008. S. aureus (27.53%) was the most common pathogen in HD patients, whereas Coagulase-negative Staphylococcus (21.3%) was the most common pathogen in PD patients. Vascular access infection was the most common etiology in HD patients, whereas peritonitis was the most common etiology in PD patients. Older age, shorter dialysis vintage, use of HD rather than PD, current smoker, use of a venous dialysis catheter, presence of diabetes mellitus, higher comorbidity score, and lower serum albumin were significant risk factors for bacteremia. Diabetes mellitus and lower serum albumin were significant risk factors for bacteremia-associated mortality. Conclusion Placement of a permanent access (fistula, graft, or PD catheter) prior to initiation of dialysis, smoking cessation, and better nutritional status (i.e. higher serum albumin) were associated with a reduced risk of bacteremia in dialysis patients. Higher serum albumin was also associated with a reduced bacteremiaassociated mortality.

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“…Comorbidity was documented as described previously and validated by prospective studies (17,18). Seven comorbid domains are considered, including noncutaneous malignancy, ischemic heart disease (IHD), peripheral vascular disease (PVD; including cerebrovascular and renovascular disease), left ventricular dysfunction (LVD; moderate to severe hypokinesia on two-dimensional echocardiogram), diabetes (the current/previous need for oral anti-diabetics or insulin), systemic collagen vascular disease, and any other condition that is known to reduce life expectancy.…”

Section: Comorbidity and Demographic Datamentioning

confidence: 99%

Peritoneal Protein Clearance and not Peritoneal Membrane Transport Status Predicts Survival in a Contemporary Cohort of Peritoneal Dialysis Patients

Perl¹,

Huckvale²,

Chellar³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: Fast peritoneal membrane transport status may be due to inflammation or increased peritoneal membrane surface area. We evaluated the ability of peritoneal protein clearance (Pcl) to distinguish fast peritoneal membrane transport status as a consequence of peritoneal membrane inflammation and assess its impact on patient survival.Design, setting, participants, & measurements: Patients who initiated peritoneal dialysis at our center since January 1998 and had a baseline peritoneal equilibration test, measurement of dialysis adequacy, and 24-h dialysate Pcl were included. Demography, comorbidities, and biochemical data were prospectively collected. Follow-up was until death or the end of the period studied. Multivariate regression analysis identified factors that were associated with Pcl. A Cox proportional hazards model was used to identify factors that were associated with survival.Results: A total of 192 patients (56% men, mean age 54.3 ؎ 15.3; 32% with diabetes) were included. On univariate analysis, Pcl was negatively correlated with serum albumin and positively correlated with age, dialysate/plasma creatinine ratio (D/Pcr), the presence of peripheral vascular disease, and urine volume. On multivariate analysis, serum albumin, D/Pcr, urine volume, and peripheral vascular disease remained significant. Predictors of mortality were age, comorbidity grade, and Pcl but not D/Pcr.Conclusions: In this cohort, peritoneal transport status no longer predicted survival, whereas Pcl remained a predictor. Increased large-pore protein loss may reflect the severity of underlying cardiovascular disease, portending a poor prognosis for these patients.

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Quantifying comorbidity in peritoneal dialysis patients and its relationship to other predictors of survival

Cited by 340 publications

References 29 publications

Risk Factors for Mortality in Stable Peritoneal Dialysis Patients

Risk Factors for Mortality in Stable Peritoneal Dialysis Patients

Bacteremia in Hemodialysis and Peritoneal Dialysis Patients

Peritoneal Protein Clearance and not Peritoneal Membrane Transport Status Predicts Survival in a Contemporary Cohort of Peritoneal Dialysis Patients

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