Risk factors for cardiovascular death in urgent-start peritoneal dialysis patients: a multicenter retrospective cohort study

Abstract

Background: Urgent-start peritoneal dialysis (USPD) has been identified as the efficient approach to initiate renal replacement treatment in end-stage renal disease patients. Cardiovascular mortality of urgent dialysis is an important issue. The present work focused on assessing risk factors related to cardiovascular death in USPD patients. Methods: We carried out the present multicenter retrospective cohort study in Northeast China, included adults initiating USPD between 2013 to 2019. Follow-up was conducted in every patient till the occurrence events below: technical failure, death, loss-to-follow-up, and renal transplantation. Results: There were altogether 1549 cases enrolled into this work. Among them, 123 encountered cardiovascular death. Upon multivariate regression, predictors of cardiovascular death included advanced age (HR 1.045, 95%CI [1.031, 1.060]; p < 0.001), higher eGFR (HR 1.084, 95%CI [1.052, 1.117]; p = 0.001), combined with diabetes (HR 1.471, 95%CI [1.026, 2.110]; p = 0.036), and advanced heart failure stages (class III versus class 0-I, HR 5.262; 95%CI [3.281, 8.437]; p < 0.001; class IV versus class 0-I, HR 6.409; 95%CI [4.145, 9.912]; p < 0.001). In addition, the predictors of cardiovascular death in diabetic USPD patients included advanced age (HR 1.050, 95%CI [1.024, 1.076]; p < 0.001), low serum creatinine (HR 0.999, 95%CI [0.998, 1.000]; p = 0.036) and advanced heart failure stage (class III versus class 0-I, HR 8.814; 95%CI [4.709, 16.501]; p< 0.001; class IV versus class 0-I, HR 5.334; 95%CI [2.904, 9.796]; p < 0.001). Moreover, the predictors of cardiovascular death in elderly USPD patients were advancedheart failure stage (class III versus class 0-I, HR 4.081; 95%CI [2.323, 7.170]; p < 0.001; class IV versus class 0-I, HR 5.178; 95%CI [3.066, 8.746]; p < 0.001). Conclusions: Risk factors related to cardiovascular death included advanced age, higher eGFR, combined with diabetes, and advanced heart failure stages among USPD patients.