Risk Factors for Mortality in Stable Peritoneal Dialysis Patients

Abstract

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.

A Comparison of the Antihypertensive and Anti-Inflammatory Effects of Aliskiren and Ramipril Add-On Therapy in Peritoneal Dialysis Patients – A Pilot Open Label Study

“…In our study neither of the drugs caused a change of serum CRP, which is a common but unspecific inflammatory marker in the dialysis patients including those treated with peritoneal dialysis [34]. Similar observations on the lack of an effect of aliskiren on CRP were made by Andersen et al [18].…”

High-Sensitivity C-Reactive Protein Predicts Mortality and Technique Failure in Peritoneal Dialysis Patients

“…Serum albumin level is an important predictor of all-cause mortality in both PD and hemodialysis patients [37], [38]. As frequently there is a reciprocal interaction between serum albumin and CRP levels, some studies have shown that on multivariate Cox regression analysis, serum CRP level instead of serum albumin level remains significant in predicting mortality [39]. In contrast, our study showed that both serum HS-CRP and albumin levels were independent risk factors for mortality and technique failure.…”

Patient characteristics and risk factors of early and late death in incident peritoneal dialysis patients

“…In line with our results, a study from USA found RRF was an important predictor of 1-year mortality in chronic PD patients by analyzing a national database—the End-Stage Renal Disease Core Indicators Project20. Another study from Korea demonstrated low RRF was significantly correlated with mortality of those who maintained PD for more than 2 years21. The plausible explanations for the importance of RRF in predicting mortality include reducing volume overload, reducing use of hypertonic dialysis solutions, increasing renal clearance of larger molecular weight molecules2223.…”