Risk factors for mortality in patients undergoing peritoneal dialysis: a systematic review and meta-analysis

Abstract

Aim: Inconsistent investigations of the risk factors for all-cause mortality in patients undergoing peritoneal dialysis (PD) were reported. The present meta-analysis aimed to assess the impact of some clinical characteristics on the risk of mortality in PD patients. Methods: PubMed and Embase were systematically searched for studies evaluating the risk factors for all-cause mortality in PD patients. Hazard ratio (HR) and 95% confidence interval (CI) were derived using a random-effect or fixed-effect model considering the heterogeneity across studies. Result: A total of 26 studies were included in this meta-analysis in accordance with the inclusion and exclusion criteria. Age, primary cardiovascular diseases, diabetes mellitus, and high level of alkaline phosphatase showed significant positive associations with elevated risk of all-cause and cardiovascular mortality in PD patients, while hemoglobin acted as a benefit factor. Furthermore, early onset of peritonitis, high peritoneal transport status, elevated body mass index and highsensitivity C-reactive protein could also considerably increase the risk of all-cause mortality. The absolute serum level of magnesium, potassium, and uric acid required to improve survival in PD patients should be verified further. Conclusions: Multiple factors could affect the risk of mortality in PD patients.

Incidence of major cardiovascular events at 1, 2, 5 years and mortality in incident patients on peritoneal dialysis regarding their nutritional status by bioimpedanciometry. A multicenter study in Colombia

“…Furthermore, it was found that 51% of the patients who died had DM, in whom, overall mortality and the incidence of major cardiovascular events were significantly higher than in the non-diabetic population, a finding that is probably related to the higher frequency of traditional risk factors for cardiovascular disease and the association with a greater degree of overhydration at the start of therapy in this population. These findings are related to those reported in a meta-analysis that analyzes the risk factors for all-cause mortality in patients on PD, where age, CVD, and DM are associated with a higher risk of cardiovascular mortality and all-cause mortality, as well as a higher rate of hospitalizations for cardiovascular causes with AMI and CVD predominating (4).…”

“…End-stage renal disease (ESRD), as well as other chronic diseases, generate systemic effects at the cardiovascular, pulmonary, endocrine, neurological, and muscular levels, among others, which lead to complications and a decrease in longterm survival (2). Muscular affectation due to the presence of sarcopenia or dinapenia is frequent in patients who join dialysis programs (3,4). The impact of cardiometabolic risk factors and other chronic diseases prevalent in this population are also added (5).…”

Dialysis Duration and Glucose Exposure Amount Do Not Increase Mortality Risk in Peritoneal Dialysis Patients: A Population-Based Cohort Study From 2004 to 2012

“…The causes of mortality in PD are both numerous and complex. Indeed, age, CV disease, DM, PD peritonitis episodes, higher body mass index, higher alkaline phosphatase, inflammation, and anemia are all associated with PD mortality ( 32 ). The small effect size of PD duration and PD glucose load on mortality may be one of the reasons that the result was not significant in our study.…”

A retrospective study of baseline peritoneal transport character and left ventricular hypertrophy in incident peritoneal dialysis patients: interrelationship and prognostic impacts

“…Furthermore, higher HbA1c and non-diabetes patients were less associated with LVMI and LAD enlargement in our study. DM appeared to predict the risk of fatal cardiovascular events and all-cause mortality in PD patients [ 39 ]. But some dialysis patients tend to have false low HbA1c levels due to anemia and erythropoiesis-stimulating agents (ESAs) use.…”