The Synergistic Value of Time-Averaged Serum Albumin and Globulin in Predicting the First Peritonitis in Incident Peritoneal Dialysis Patients

2019 ◽  
Vol 49 (3) ◽  
pp. 272-280
Author(s):  
Wenyu Zhang ◽  
Xichao Wang ◽  
Ying Liu ◽  
Yingying Han ◽  
Jinping Li ◽  
...  

Background: The prognostic value of serum time-averaged albumin (TA-Alb) and time-averaged globulin (TA-Glo) combination on the peritonitis in peritoneal dialysis (PD) patients is unknown. Methods: The patients who started PD treatment between July 2013 and 2018 were included. Serum Alb and globulin (Glo) were tested at baseline and monthly during follow-up. TA-Alb and TA-Glo were calculated until first peritonitis occurred or the end of the study. PD patients were divided into 4 groups based on the medians of TA-Alb and TA-Glo separately. Cox regression was conducted to identify the hazard ratios (HRs) of peritonitis among categorical groups. Results: Three hundred and sixty-three patients were included and among them 109 patients experienced first peritonitis. Peritonitis patients had lower baseline Alb, TA-Alb, and TA-Glo levels and ultrafiltration volume. Multivariate cox regression analysis revealed that TA-Alb, TA-Glo, and baseline Alb were significantly associated with first peritonitis. The highest HR existed in Group 1 with lower Alb and lower Glo (HR 4.57, 95% CI 2.36–8.87, p < 0.001) compared with Group 4 with higher Alb and higher Glo. Conclusion: Lower TA-Glo is an independent risk factor for the first peritonitis in PD patients. Combined with lower TA-Alb will increase the predictive effect than separate factor alone.

Cephalalgia ◽  
2013 ◽  
Vol 34 (5) ◽  
pp. 327-335 ◽  
Author(s):  
Knut Hagen ◽  
Eystein Stordal ◽  
Mattias Linde ◽  
Timothy J Steiner ◽  
John-Anker Zwart ◽  
...  

Background Headache has not been established as a risk factor for dementia. The aim of this study was to determine whether any headache was associated with subsequent development of vascular dementia (VaD), Alzheimer’s disease (AD) or other types of dementia. Methods This prospective population-based cohort study used baseline data from the Nord-Trøndelag Health Study (HUNT 2) performed during 1995–1997 and, from the same Norwegian county, a register of cases diagnosed with dementia during 1997–2010. Participants aged ≥20 years who responded to headache questions in HUNT 2 were categorized (headache free; with any headache; with migraine; with nonmigrainous headache). Hazard ratios (HRs) for later inclusion in the dementia register were estimated using Cox regression analysis. Results Of 51,383 participants providing headache data in HUNT 2, 378 appeared in the dementia register during the follow-up period. Compared to those who were headache free, participants with any headache had increased risk of VaD ( n = 63) (multivariate-adjusted HR = 2.3, 95% CI 1.4–3.8, p = 0.002) and of mixed dementia (VaD and AD ( n = 52)) (adjusted HR = 2.0, 95% CI 1.1–3.5, p = 0.018). There was no association between any headache and later development of AD ( n = 180). Conclusion In this prospective population-based cohort study, any headache was a risk factor for development of VaD.


2020 ◽  
Vol 9 (9) ◽  
pp. 3009
Author(s):  
José Antonio Rubio ◽  
Sara Jiménez ◽  
José Luis Lázaro-Martínez

Background: This study reviews the mortality of patients with diabetic foot ulcers (DFU) from the first consultation with a Multidisciplinary Diabetic Foot Team (MDFT) and analyzes the main cause of death, as well as the relevant clinical factors associated with survival. Methods: Data of 338 consecutive patients referred to the MDFT center for a new DFU during the 2008–2014 period were analyzed. Follow-up: until death or until 30 April 2020, for up to 12.2 years. Results: Clinical characteristics: median age was 71 years, 92.9% had type 2 diabetes, and about 50% had micro-macrovascular complications. Ulcer characteristics: Wagner grade 1–2 (82.3%), ischemic (49.2%), and infected ulcers (56.2%). During follow-up, 201 patients died (59.5%), 110 (54.7%) due to cardiovascular disease. Kaplan—Meier curves estimated a reduction in survival of 60% with a 95% confidence interval (95% CI), (54.7–65.3) at 5 years. Cox regression analysis adjusted to a multivariate model showed the following associations with mortality, with hazard ratios (HRs) (95% CI): age, 1.07 (1.05–1.08); HbA1c value < 7% (53 mmol/mol), 1.43 (1.02–2.0); active smoking, 1.59 (1.02–2.47); ischemic heart or cerebrovascular disease, 1.55 (1.15–2.11); chronic kidney disease, 1.86 (1.37–2.53); and ulcer severity (SINBAD system) 1.12 (1.02–1.26). Conclusion: Patients with a history of DFU have high mortality. Two less known predictors of mortality were identified: HbA1c value < 7% (53 mmol/mol) and ulcer severity.


2020 ◽  
Author(s):  
Masanori Kaneko ◽  
Kazuya Fujihara ◽  
Taeko Osawa ◽  
Masahiko Yamamoto ◽  
Mayuko Yamada Harada ◽  
...  

Abstract Background: Because amputation negatively affects the quality of life of patients with diabetes and increases the risk of cardiovascular events and mortality, predictors of amputation must be identified. However, no large cohort studies have been conducted regarding the incidence of amputation in patients with diabetes in East Asia.Methods: We analyzed data from a nationwide claims database in Japan accumulated from 2008–2016, involving 17,288 patients with diabetes aged 18–72 y (2942 women, mean age 50.2 y, HbA1c 7.2%).Results: The mean follow-up time was 5.3 years, and 16 amputations occurred (0.17/1000 person-years). Multivariate Cox regression analysis showed that age and HbA1c levels were independent predictors of amputation (hazard ratios [HRs], 1.09 and 1.43; 95% confidence intervals [CIs], 1.01–1.16 and 1.12–1.82, respectively). Compared with patients aged <60 y and with HbA1c <8%, the HR for patients aged ≥60 y and with HbA1c ≥8% was 32.1 (95% CI, 7.30–141.2).Conclusions: Improved glycemic control may lower amputation risk.


2020 ◽  
Author(s):  
Xiaohan You ◽  
Ying Zhou ◽  
Jianna Zhang ◽  
Qiongxiu Zhou ◽  
Yanling Shi ◽  
...  

Abstract Background : Continuous ambulatory peritoneal dialysis (CAPD) patients have a high incidence of stroke and commonly have increased parathyroid hormone levels and vitamin D insufficiency. We seek to investigate the incidence of stroke and the role of parathyroid hormone and vitamin D supplementation in stroke risk among CAPD patients. Methods: This study employed a retrospective design. We enrolled a Chinese cohort of 980 CAPD patients who were routinely followed in our department. The demographic and clinical data were recorded at the time of initial CAPD and during follow-up. The included patients were separated into non-stroke and stroke groups. The effects of parathyroid hormone and vitamin D supplementation on stroke in CAPD patients was evaluated. The primary endpoint is defined as the first occurrence of stroke, and composite endpoint events are defined as death or switch to hemodialysis during follow-up. Results: A total of 757 eligible CAPD patients with a mean follow-up time of 54.7 (standard deviation, 33) months were included in the study. The median incidence of stroke among our CAPD patients was 18.9 (interquartile range, 15.7 - 22.1) per 1000 person-years. A significant nonlinear correlation between baseline iPTH and hazard of stroke (p-value of linear association = 0.2 and nonlinear association = 0.002) was observed in our univariate Cox regression analysis, and low baseline iPTH levels (≤150 pg/ml) were associated with an increased cumulative hazard of stroke. Multivariate Cox regression analysis indicated a significant interaction effect between age and iPTH after adjusting for other confounders. Vitamin D supplementation during follow-up was a predictive factor for stroke in our cohort. Conclusions: CAPD patients suffered a high risk of stroke, and lower iPTH levels were significantly correlated with an increased risk of stroke. Nevertheless, vitamin D supplementation may reduce the risk of stroke in these patients.


2020 ◽  
Author(s):  
Xiaohan You ◽  
Ying Zhou ◽  
Jianna Zhang ◽  
Qiongxiu Zhou ◽  
Yanling Shi ◽  
...  

Abstract Background Continuous ambulatory peritoneal dialysis (CAPD) patients have a high incidence of stroke and commonly have increased parathyroid hormone levels and vitamin D insufficiency. We seek to investigate the incidence of stroke and the role of parathyroid hormone and vitamin D supplementation in stroke risk among CAPD patients.Methods This is a retrospective study enrolled a Chinese cohort of 980 CAPD patients who were routinely followed up in our department. The demographic and clinical data recorded at the time of initial CAPD and during follow-up time are collected. The included cases were separated into nonstroke and stroke groups. The role of parathyroid hormone and vitamin D supplementation for stroke in CAPD patients is evaluated. The primary endpoint is defined as the first-time occurrence of stroke, and composite endpoint events are defined as death or switch to hemodialysis during follow-up.Results A total of 757 eligible CAPD patients with a mean follow-up time of 54.7 (standard deviation (SD) 33) months were included in the study. The median incidence of stroke among our CAPD patients was 18.9 (IQR, 15.7 - 22.1) per 1000 person-years. A significant nonlinear correlation between baseline iPTH and hazard of stroke (p value of linear association = 0.2 and nonlinear association = 0.002) was observed in our univariate Cox regression analysis, and low baseline iPTH levels (≤150 pg/ml) were associated with an increased cumulative hazard of stroke. Multivariate Cox regression analysis indicated a significant interaction effect between age and iPTH after adjusting for other confounders. Vitamin D supplementation during follow-up was a predictive factor for stroke in our cohort.Conclusions CAPD patients suffered a high risk of stroke. Lower iPTH levels were significantly associated with an increased risk of stroke. Vitamin D supplementation is an independent predictive factor for stroke among CAPD patients.


2018 ◽  
Vol 7 (11) ◽  
pp. 416 ◽  
Author(s):  
Kuan-Ju Lai ◽  
Chew-Teng Kor ◽  
Yao-Peng Hsieh

Background: The results have been inconsistent with regards to the impact of uric acid (UA) on clinical outcomes both in the general population and in patients with chronic kidney disease. The aim of this study was to study the influence of serum UA levels on mortality in patients undergoing continuous ambulatory peritoneal dialysis. Methods: Data on 492 patients from a single peritoneal dialysis unit were retrospectively analyzed. The mean age of the patients was 53.5 ± 15.3 years, with 52% being female (n = 255). The concomitant comorbidities at the start of continuous ambulatory peritoneal dialysis (CAPD) encompassed diabetes mellitus (n = 179, 34.6%), hypertension (n = 419, 85.2%), and cardiovascular disease (n = 186, 37.9%). The study cohort was divided into sex-specific tertiles according to baseline UA level. A Cox proportional hazard model was used to calculate hazard ratios (HRs) of all-cause, cardiovascular, and infection-associated mortality with adjustments for demographic and laboratory data, medications, and comorbidities. Results: Multivariate Cox regression analysis showed that, using UA tertile 1 as the reference, the adjusted HR of all-cause, cardiovascular, and infection-associated mortality for tertile 3 was 0.4 (95% confidence interval (CI) 0.24–0.68, p = 0.001), 0.4 (95% CI 0.2–0.81, p = 0.01), and 0.47 (95% CI 0.19–1.08, p = 0.1). In the fully adjusted model, the adjusted HRs of all-cause, cardiovascular, and infection-associated mortality for each 1-mg/dL increase in UA level were 0.84 (95% CI, 0.69–0.9, p = 0.07), 0.79 (95% CI, 0.61–1.01, p = 0.06), and 0.79 (95% CI, 0.48–1.21, p = 0.32) for men and 0.57 (95% CI, 0.44–0.73, p < 0.001), 0.6 (95% CI, 0.41–0.87, p = 0.006), and 0.41 (95% CI, 0.26–0.6, p < 0.001) for women, respectively. Conclusions: Higher UA levels are associated with lower risks of all-cause, cardiovascular and infection-associated mortality in women treated with continuous ambulatory peritoneal dialysis.


2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Iryna Shifris ◽  
Anna Shymova ◽  
Iryna Dudar

Abstract Background and Aims The worldwide medical public attention focuses on the problems associated with decreasing morbidity frequency and improving of survival of patients with the end stage renal disease (ESRD). Peritoneal dialysis (PD), including continuous ambulatory peritoneal dialysis (CAPD), one of the known modality of renal replacement therapy (RRT). Several studies demonstrated that namely nutritional. The aim of this study was to explore the relationship between the nutritional status in PD patients and their morbidity and mortality. Method This study was an observational, prospective, epidemiological tracking by clinical examination. The study included 105 patients with ESRD who started CAPD treated in single dialysis center of Ukraine (during 2012 - 2018). Fifty three (50.5%) patients were male, median age 60 (range 25–85 years) and the most common cause of ESRD was glomerulonephritis (63 patients, 60.0%). Median follow-up was 29 months (range 6- 132 months). Nutritional status (NS) indicators defined basing on the calculation of the subjective global assessment (SGA, points). Patients were classified into four groups according to their NS. Group 1 included 51 patients with normal NS, group 2- 30 patients with a light degree of malnutrition, group 3 (13 patients) and group 4 (11 patients) with moderate and severe degree of nutritional disorders, respectively. During follow-up, all hospital admissions and all causes of mortality were documented and compared for nutritional disorders versus normal NS. Results During follow up the 62 hospitalization cases (30 cardiovascular events, 15 PD-peritonitis, 13 other bacterial infections, 2 stroke and 2 - others) and 46 deaths among all patients were detected. The odds ratio for all-cause hospitalization in the group 3 (12/85.7% vs. 26/ 51.0%) were significantly higher than in the group 1 (OR = 5.7692, 95% CI: 1.1712 - 28.4178; р= 0.0312). A significant increasing of the hospitalization incidences both due infectious comorbidity (7/63.64% vs. 8/15.7%; χ²= 8.880, p = 0.003) among patients with severe degree of malnutrition compared with patients group 1. At the same time, cardiovascular (CVD) hospitalization rate was significantly higher in patients group 3 (8/57.1% vs. 10/ 19.6%; χ²= 5.968, p = 0.015) than in the group1. Mortality rate was significantly higher in patients group with moderate (11/84.6% vs 16/31.37%, χ²= 12.041, p &lt;0.0001; OR =12.031; 95% CI: 2.3843 - 60.7105) and a light degree of nutritional disorders (11/84.6% vs 13/43.4%, χ²= 6.267, p= 0.013; OR = 7.1923; 95% CI: 1.352- 38.2367) than with normal NS. Similarly, patients with a severe degree of malnutrition (group 4) showed a higher mortality rate versus patients group1: 8/72.7%% vs. 16/31.37%,; χ²= 6.522, р= 0.011 (OR = 5.8333, 95% CI: 1.3645-24.9376). Cardiovascular disease was the leading cause of death (22/47.8%). Conclusion Thus, the obtained findings suggest that nutritional disorders at PD initiation have a significant negative effect on prognosis. The results of our study demonstrated the predictive role of assessing nutritional status in all-cause mortality and hospital admissions in ESRD population.


2020 ◽  
Author(s):  
Renjiao Li ◽  
Wen-Jun Zhu ◽  
Faping Wang ◽  
Xiaoju Tang ◽  
Fengming Luo

Abstract ObjectiveTo assess the associations between aspartate transaminase/alanine transaminase ratio (DRR) and mortality in patients with Polymyositis/dermatomyositis associated interstitial lung disease (PM/DM-ILD).Patients and MethodsThis was a retrospective cohort study, which included 522 patients with PM/DM-ILD whose DRR on admission were tested at West China Hospital of Sichuan University during the period from January 1, 2008 to December 31, 2018. Cox regression models were used to estimate hazard ratios for mortality in four predefined DRR strata (≤ 0.91, 0.91–1.26, 1.26–1.73 and > 1.73), after adjusting for age, sex, DRR stratum, diagnosis, overlap syndrome, hemoglobin, platelet count, white blood cell count, the percentage of neutrophils, neutrophil/lymphocyte ratio, albumin, creatine kinase, uric acid/creatinine ratio, triglycerides or low density lipoprotein.ResultsHigher DRR (> 1.73) was an independent predictor of 1-year mortality in multivariate Cox regression analysis (hazard ratio 3.423, 95% CI 1.481–7.911, p = .004). Patients with higher DRR more often required use of mechanical ventilation and readmission for acute exacerbation of PM/DM-ILD at 1-year follow-up.ConclusionHigher DRR on admission for PM/DM-ILD patients are associated with increased mortality, risk of mechanical ventilation and hospitalization in 1-year follow-up. This low-cost, easy-to-obtain, rapidly measured biomarker may be useful in the identification of high-risk PM/DM-ILD patients that could benefit from intensive management.


2020 ◽  
Author(s):  
Wenkai Xia ◽  
Xiajuan Yao ◽  
Yan Chen ◽  
Jie Lin ◽  
Volker Vielhauer ◽  
...  

Abstract Background and Aims: Dyslipidemia is common in patients with chronic kidney disease and particular prevalent in patients receiving peritoneal dialysis. However, whether markers of atherogenic dyslipidemia correlate with outcomes in dialysis patients as in the general population is uncertain. Here, we investigated the prognostic value of the serum triglyceride/HDL cholesterol (TG/HDL-C) ratio and non-HDL-C/HDL-C ratio in peritoneal dialysis patients to predict all-cause mortality. Methods 214 PD patients were retrospectively analyzed from January 2011 to December 2015, with a median follow-up of 59 months. We used receiver operating curves (ROC) to determine the optimal threshold for TG/HDL-C and non-HDL/HDL-C ratios at baseline to predict OS during follow-up. Prognostic values were accessed by univariate and multivariate COX regression analysis and Kaplan-Meier curve. A predictive nomogram was developed to predict prognosis for overall survival, and the predictive accuracy was evaluated by concordance index (c-index). Results The optimal cut-off values for TG/HDL-C ratio and non-HDL-C/HDL-C ratio were 1.94 and 2.86, respectively. A high TG/HDL-C ratio and a high non-HDL-C/HDL-C ratio strongly correlated with worse OS in PD patients. Multivariate analysis demonstrated that elevated TG/HDL-C ratio as well as non-HDL/HDL-C ratios were independent markers to predict reduced OS. The TG/HDL-C ratio (HR 2.60, 95% CI 1.40–4.83, P = 0.002) was superior to non-HDL-C/HDL-C ratio based on hazard ratio (HR 2.43, 95% CI 1.09–5.40, P = 0.029). Conclusion TG/HDL-C ratio and non-HDL-C/HDL-C were identified as potential prognostic biomarkers in PD patients. The proposed nomograms can be utilized for prediction of OS in PD patients.


2016 ◽  
Vol 6 (3) ◽  
pp. 251-259
Author(s):  
Masaru Matsui ◽  
Ken-ichi Samejima ◽  
Yukiji Takeda ◽  
Katsuhiko Morimoto ◽  
Miho Tagawa ◽  
...  

Background: Placental growth factor (PlGF) is a member of the vascular endothelial growth factor family that acts as a pleiotropic cytokine capable of stimulating angiogenesis and accelerating atherogenesis. Soluble fms-like tyrosine kinase-1 (sFlt-1) antagonizes PlGF action. Higher levels of PlGF and sFlt-1 have been associated with cardiovascular events in patients with chronic kidney disease, yet little is known about their relationship with adverse outcomes in patients on peritoneal dialysis (PD). The aim of this study was to investigate the association of PlGF and sFlt-1 with technique survival and cardiovascular events. Methods: We measured serum levels of PlGF and plasma levels of sFlt-1 in 40 PD patients at Nara Medical University. Results: PlGF and sFlt-1 levels were significantly correlated with the dialysate-to-plasma ratio of creatinine (r = 0.342, p = 0.04 and r = 0.554, p < 0.001) although PlGF and sFlt-1 levels were not correlated with total creatinine clearance and total Kt/V. Additionally, both PlGF and sFlt-1 levels were significantly higher in patients with high transport membranes compared to those without (p = 0.039 and p < 0.001, respectively). Patients with PlGF levels above the median had lower technique survival and higher incidence of cardiovascular events than patients with levels below the median, with hazard ratios of 11.9 and 7.7, respectively, in univariate Cox regression analysis. However, sFlt-1 levels were not associated with technique survival or cardiovascular events (p = 0.11 and p = 0.10, respectively). Conclusion: Elevated PlGF and sFlt-1 are significantly associated with high transport membrane status. PlGF may be a useful predictor of technique survival and cardiovascular events in PD patients.


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