scholarly journals Serum Sodium Modifies the Association of Systolic Blood Pressure with Mortality in Peritoneal Dialysis Patients

2020 ◽  
Vol 45 (6) ◽  
pp. 916-925
Author(s):  
Yagui Qiu ◽  
Hongjian Ye ◽  
Li Fan ◽  
Xunhua Zheng ◽  
Wei Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Serum Sodium ◽  
Subgroup Analysis ◽  
Continuous Variable ◽  
Cox Proportional Hazards ◽  
Dialysis Patients ◽  
Baseline Serum ◽  
All Cause Mortality ◽  
Cv Disease

<b><i>Introduction:</i></b> High serum sodium is associated with increased blood pressure (BP) in dialysis patients, which is a risk factor for cardiovascular (CV) disease. However, the interaction between serum sodium and BP and their association with clinical outcomes in peritoneal dialysis (PD) patients is uncertain. <b><i>Methods:</i></b> We analyzed a retrospective cohort of 1,656 incident PD patients from January 2006 to December 2013, who were followed up until December 2018. Cox proportional hazards regression models were used to evaluate the association of serum sodium and BP with all-cause and CV mortality. A priori interaction between serum sodium and systolic BP (SBP) was explored, and a subgroup analysis was performed by stratifying SBP into the following 3 groups: &#x3c;110, 110–130, and &#x3e;130 mm Hg. <b><i>Results:</i></b> Mean baseline serum sodium was 140.2 ± 3.6 mmol/L, mean SBP was 137 ± 20 mm Hg, and diastolic BP was 85 ± 14 mm Hg. During a median (range) follow-up time of 46.5 (2.6–154.3) months, 507 patients died, 252 of whom died due to CV disease. SBP did not predict all-cause and CV mortality when BP was assessed as a continuous variable. However, SBP &#x3e;130 or &#x3c;110 mm Hg was associated with higher risk of all-cause and CV mortality compared with SBP of 110–130 mm Hg. There was a significant interaction between baseline serum sodium and SBP for all-cause mortality (<i>p</i> for interaction = 0.016). In subgroup analysis, among those with SBP &#x3e;130 mm Hg, the risk of all-cause mortality was elevated in those with serum sodium ≥140 mmol/L (adjusted hazard ratio [aHR] 1.45 [95% confidence interval (CI): 1.07–1.98]), but not for those with serum sodium &#x3c;140 mmol/L (aHR 1.27 [95% CI: 0.89–1.82]). Conversely, among those with SBP &#x3c;110 mm Hg, those with serum sodium &#x3c;140 mmol/L had an elevated risk of mortality (aHR 1.99 [95% CI: 1.31–3.02]), but not those with serum sodium ≥140 mmol/L (aHR 1.15 [95% CI: 0.74–1.79]) (<i>p</i> for interaction = 0.028). <b><i>Conclusion:</i></b> The association of BP with mortality was modified by serum sodium levels in PD patients. Further studies are needed to evaluate whether individualized BP control based on serum sodium levels contributes to improve patient outcomes.

Age Difference in the Association between Hyponatremia and Infection-Related Mortality in Peritoneal Dialysis Patients

2020 ◽  
Vol 49 (5) ◽  
pp. 631-640
Author(s):  
Yagui Qiu ◽  
Hongjian Ye ◽  
Yating Wang ◽  
Zhong Zhong ◽  
Hongyu Li ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Serum Sodium ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Control Group ◽  
Age Difference ◽  
Baseline Serum ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Related Mortality

Objectives: This study aimed to examine the association of serum sodium with infection-related mortality and its age difference among continuous ambulatory peritoneal dialysis (CAPD) patients. Methods: A total of 1,656 CAPD patients from January 2006 to December 2013 were included in this study. All patients were followed up until December 2018. Hyponatremia was defined as serum sodium <135 mmol/L. Cox proportional hazards regression model was used to investigate the relationship between baseline serum sodium levels and infection-related mortality. Results: Participants were aged 47.5 ± 15.3 years, 666 (40.2%) patients were female. Glomerulonephritis was the main cause of end-stage renal disease (61.1%). After a median of 46 months of follow-up, 507 patients died. Among the deaths, 252 (49.7%) died from cardiovascular diseases, 105 (20.7%) from infections, and 150 (29.6%) from other causes. The overall infection-related mortality was 14.8 events per 1,000 patients-year, which was higher in patients aged ≥50 years than those younger than 50 years (28.3 vs. 5.3 events per 1,000 patients-year). In the entire cohort, hyponatremia at was not associated with infection-related (hazards ratios [HR] 1.66, 95% CI 0.91–3.02) and all-cause mortality (HR 1.14, 95% CI 0.83–1.57) after adjusting for potential confounders. There was a significant interaction by age of association of serum sodium with infection-related (p = 0.002) and all-cause (p = 0.0002) death. Age-stratified analysis showed that compared with control group, hyponatremia was independently related to increased risks of infection-related death, but not all-cause mortality in patients aged ≥50 years, with HR of 2.32 (95% CI 1.25–4.32) and 1.33 (95% CI 0.95–1.87), respectively. Conclusions: Hyponatremia was associated with increased risk of infection-related mortality in CAPD patients aged ≥50 years.

Association of pulse pressure with all-cause mortality in young adults

2019 ◽  
Vol 96 (1138) ◽  
pp. 461-466
Author(s):  
Jie LI ◽  
Jia-Yi Huang ◽  
Kenneth Lo ◽  
Bin Zhang ◽  
Yu-Qing Huang ◽  
...  
Keyword(s):  
Young Adults ◽  
Pulse Pressure ◽  
Subgroup Analysis ◽  
Proportional Hazards ◽  
Continuous Variable ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Cox Analysis

BackgroundPulse blood pressure was significantly associated with all-cause mortality in middle-aged and elderly populations, but less evidence was known in young adults.ObjectiveTo assess the association of pulse pressure (PP) with all-cause mortality in young adults.MethodsThis cohort from the 1999–2006 National Health and Nutrition Examination Survey included adults aged 18–40 years. All included participants were followed up until the date of death or 31 December 2015. PP was categorised into three groups: <50, 50~60, ≥60 mm Hg. Cox proportional hazards models and subgroup analysis were performed to estimate the adjusted HRs and 95% CIs for all-cause mortality.ResultsAfter applying the exclusion criteria, 8356 participants (median age 26.63±7.01 years, 4598 women (55.03%)) were included, of which 265 (3.17%) have died during a median follow-up duration of 152.96±30.45 months. When treating PP as a continuous variable, multivariate Cox analysis showed that PP was an independent risk factor for all-cause mortality (HR 1.94, 95% CI 1.02 to 3.69; p=0.0422). When using PP<50 mm Hg as referent, from the 50~60 mm Hg to the ≥60 mm Hg group, the risks of all-cause mortality for participants with PP ranging 50–60 mm Hg or ≥60 mm Hg were 0.93 (95% CI 0.42 to 2.04) and 1.15 (95% CI 0.32 to 4.07) (P for tend was 0.959). Subgroup analysis showed that PP (HR 2.00, 95% CI 1.05 to 3.82; p=0.0360) was associated with all-cause mortality among non-hypertensive participants.ConclusionAmong young adults, higher PP was significantly associated with an increased risk of all-cause mortality, particularly among those without hypertension.

Effect of Sedative-Hypnotic Medicines on Mortality in Peritoneal Dialysis Patients with Sleep Disorders: A Retrospective Cohort Study

2017 ◽  
Vol 45 (1-3) ◽  
pp. 95-101
Author(s):  
Ying Zhou ◽  
Peiran Yin ◽  
Bin Li ◽  
Jianying Li ◽  
Naya Huang ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Sleep Disorders ◽  
Older Patients ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Dialysis Patients ◽  
Factors Associated ◽  
Cox Proportional Hazards Models ◽  
Hypnotic Medication ◽  
All Cause Mortality

Background: Sedative-hypnotic medication is widely used among continuous ambulatory peritoneal dialysis (CAPD) patients with sleep disorders; however, its effect on mortality has rarely been investigated. Methods: Logistic regression was employed to identify factors associated with sedative-hypnotic medication, whose effect on mortality was evaluated by Cox proportional hazards models. Results: A total of 146 CAPD patients with sleep disorders were recruited, of which 46 patients (31.5%) used either benzodiazepines or zolpidem. Sedative-hypnotic medication was more frequently used by older patients and those with longer duration of CAPD therapy and there was no significant association between sedative-hypnotic medicines and all-cause mortality after adjusting for age, gender, diabetes, cardiovascular disease, and duration of CAPD. Conclusion: Sedative-hypnotic medication was more often used by older patients and patients with a longer duration of CAPD. There was no association between these agents and all-cause mortality in CAPD patients with sleep disorders.

scholarly journals Superiority of glycated albumin over glycated haemoglobin as indicator of glycaemic control and predictor of all-cause mortality in patients with type 2 diabetes mellitus receiving peritoneal dialysis

2019 ◽  
Vol 56 (6) ◽  
pp. 684-691 ◽  
Author(s):  
Mizuki Miyabe ◽  
Masafumi Kurajoh ◽  
Katsuhito Mori ◽  
Senji Okuno ◽  
Shigeki Okada ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Peritoneal Dialysis ◽  
Glycaemic Control ◽  
Plasma Glucose ◽  
Glycated Albumin ◽  
Glycated Haemoglobin ◽  
Cox Proportional Hazards ◽  
Albumin Concentration ◽  
Dialysis Patients ◽  
All Cause Mortality

Background Glycated albumin, in contrast to glycated haemoglobin, precisely reflects glycaemic control and predicts all-cause mortality in haemodialysis patients with diabetes mellitus. However, whether those associations exist in diabetes mellitus patients receiving peritoneal dialysis remains unclear. Methods This was a retrospective cross-sectional and longitudinal observational study. We measured glycated albumin, glycated haemoglobin and casual plasma glucose for two months in diabetes mellitus-peritoneal dialysis ( n = 44) and diabetes mellitus-haemodialysis ( n = 88) patients (age-, gender-matched). The diabetes mellitus-peritoneal dialysis patients were followed for three years to monitor occurrence of all-cause mortality. Results Glycated albumin and glycated albumin/casual plasma glucose ratios, but not casual plasma glucose, glycated haemoglobin, or glycated haemoglobin/casual plasma glucose, were significantly lower in the diabetes mellitus-peritoneal dialysis as compared with the diabetes mellitus-haemodialysis patients. The regression lines between casual plasma glucose and glycated albumin showed a significant parallel shift downwards in diabetes mellitus-peritoneal dialysis as compared with diabetes mellitus-haemodialysis patients, while the slope did not differ significantly between the groups, resulting in underestimation of glycaemic control by 4.5%. Kapan-Meier analysis of the diabetes mellitus-peritoneal dialysis patients revealed that higher glycated albumin (median >18.0%), but not glycated haemoglobin (median >6.6%), indicated significantly elevated risk for all-cause mortality, which occurred in 15 patients (34.1%), as compared with those with a lower glycated albumin concentration. Higher glycated albumin concentration was also significantly and independently associated with all-cause mortality in multivariate Cox proportional hazards analysis. Conclusions Glycated albumin, in contrast to glycated haemoglobin, more precisely reflects glycaemic control in diabetes mellitus-peritoneal dialysis patients, based on its significant association with all-cause mortality. Furthermore, adjustment of the true glycated albumin concentration by adding 4.5% might provide a more precise measurement for determining glycaemic control in such patients.

Impact of Baseline Neutrophil-to-Lymphocyte Ratio on Long-Term Prognosis in Patients With Atrial Fibrillation

Angiology ◽  
2021 ◽  
pp. 000331972110004
Author(s):  
Shuang Wu ◽  
Yan-min Yang ◽  
Jun Zhu ◽  
Jia-meng Ren ◽  
Juan Wang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Continuous Variable ◽  
Cox Proportional Hazards ◽  
Neutrophil To Lymphocyte Ratio ◽  
Long Term Outcomes ◽  
Lymphocyte Ratio ◽  
Net Reclassification Improvement ◽  
Increased Risk ◽  
All Cause Mortality

We performed a retrospective analysis involving 1269 patients with atrial fibrillation (AF) to evaluate the predictive value of the neutrophil-to-lymphocyte ratio (NLR) on long-term outcomes. The primary outcomes were all-cause mortality and combined end point events (CEEs). Cox proportional hazards regression analysis and net reclassification improvement (NRI) analysis were performed. During a median follow-up of 3.32 years, 285 deaths and 376 CEEs occurred. With the elevation of the NLR, the incidence of all-cause mortality (2.77, 4.14, 6.12, and 12.18/100 person-years) and CEEs (4.19, 7.40, 8.03, and 15.22/100 person-years) significantly increased. Multivariate Cox analysis indicated that the highest NLR quartile was independently associated with the incidence of all-cause mortality (hazard ratio [HR] = 1.77, 95% CI: 1.19-2.65) and CEEs (HR = 1.66, 95% CI: 1.18-2.33). When the NLR was analyzed as a continuous variable, a 1-unit increment in log NLR was related to 134% increased risk of all-cause mortality and 119% increased risk of CEEs. Net reclassification improvement analysis revealed that NLR significantly improved risk stratification for all-cause death and CEEs by 15.0% and 9.6%, respectively. Neutrophil-to-lymphocyte ratio could be an independent predictor of long-term outcomes in patients with AF.

Elevated Serum Trimethylamine N-Oxide Levels Are Associated with Mortality in Male Patients on Peritoneal Dialysis

2021 ◽  
pp. 1-11
Author(s):  
Dongying Fu ◽  
Jiani Shen ◽  
Wei Li ◽  
Yating Wang ◽  
Zhong Zhong ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Proportional Hazards ◽  
Elevated Serum ◽  
Ultra Performance Liquid Chromatography ◽  
Cox Proportional Hazards ◽  
Serum Samples ◽  
Entire Cohort ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Male Patients

Background: Elevated levels of serum trimethylamine N-oxide (TMAO) have been previously linked to adverse cardiovascular (CV) and all-cause mortality in hemodialysis patients. However, the clinical significance of serum TMAO levels in patients treated with peritoneal dialysis (PD) is unclear. Methods: A total of 1,032 PD patients with stored serum samples at baseline were enrolled in this prospective study. Serum concentrations of TMAO were quantified by ultra-performance liquid chromatography-tandem mass spectrometry. Cox proportional hazards and competing-risk regression models were performed to examine the association of TMAO levels with all-cause and CV mortality. Results: The median level of serum TMAO in our study population was 34.5 (interquartile range (IQR), 19.8–61.0) μM. During a median follow-up of 63.7 months (IQR, 43.9–87.2), 245 (24%) patients died, with 129 (53%) deaths resulting from CV disease. In the entire cohort, we observed an association between elevated serum TMAO levels and all-cause mortality (adjusted subdistributional hazard ratio [SHR], 1.22; 95% confidence interval [95% CI], 1.01–1.48; p = 0.039) but not CV mortality. Further analysis revealed such association differed by sex; the elevation of serum TMAO levels was independently associated with increased risk of both all-cause (SHR, 1.37; 95% CI, 1.07–1.76; p = 0.013) and CV mortality (SHR, 1.41; 95% CI, 1.02–1.94; p = 0.038) in men but not in women. Conclusions: Higher serum TMAO levels were independently associated with all-cause and CV mortality in male patients treated with PD.

FC 100ASSOCIATION OF SINGLE AND SERIAL MEASURES OF SERUM PHOSPHORUS WITH ADVERSE OUTCOMES IN PATIENTS ON PERITONEAL DIALYSIS: RESULTS FROM THE INTERNATIONAL PDOPPS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Marcelo Lopes ◽  
Angelo Karaboyas ◽  
David W Johnson ◽  
Talerngsak Kanjanabuch ◽  
Martin Wilkie ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Adverse Outcomes ◽  
Serum Phosphorus ◽  
Target Range ◽  
Recent Measurement ◽  
Baseline Serum ◽  
All Cause Mortality ◽  
Serial Measurements ◽  
Phosphorus Levels

Abstract Background and Aims While it has been established that high serum phosphorus is associated with mortality in hemodialysis (HD) patients, there is limited evidence in the peritoneal dialysis (PD) setting. We evaluated the association of serum phosphorus with mortality and major adverse cardiovascular events (MACE) in patients on PD, and investigated various parameterizations using single and serial measurements of serum phosphorus. Method We utilized data from 7 countries in phase 1 (2014-2017) of the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS): Australia, Canada, Japan, New Zealand, Thailand, the UK, and the US. We investigated the association of serum phosphorus and 3 outcomes: all-cause mortality, cardiovascular (CV) mortality, and MACE (CV mortality + non-fatal angina, myocardial infarction, stroke, and heart failure). We parameterized serum phosphorus using 4 different methods: (1) single measurement of baseline serum phosphorus [most recent measurement during 6-month run-in period]; (2) mean serum phosphorus over a 6-month run-in period; (3) number of months (over the past 6 months) with serum phosphorus above the target range (&gt;4.5 mg/dL); (4) mean area-under-the-curve (AUC), calculated as the average amount of time spent with serum phosphorus &gt;4.5 mg/dL multiplied by the extent to which this threshold was exceeded over 6 months. Cox regression was used to estimate the association between each of these 4 exposures with the time-to-event outcomes, in models thoroughly adjusted for possible confounders. Follow-up began after the 6-month run-in period and continued until the outcome occurred, 7 days after leaving the facility due to transfer or change in kidney replacement therapy modality, loss to follow-up, or end of study phase (whichever event occurred first). Results Our sample consisted of 5904 patients who were on PD. Those with higher serum phosphorus levels were younger and had lower hemoglobin levels. Compared to patients with serum phosphorus ≥3.5 to &lt;4.5 mg/dL, we found an all-cause mortality hazard ratio (HR) of 1.62 (95% CI: 1.19, 2.20) for patients with serum phosphorus ≥ 7 mg/dL. Strong associations were also observed using serial phosphorus measures [Table]. For example, compared to the reference group of AUC=0, the HR (95% CI) of death was 1.49 (1.10, 2.00) for AUC &gt;1 to 2; and 1.67 (1.15, 2.41) for AUC &gt;2. Akaike Information Criteria (AIC) results showed that, among the 4 exposures, AUC was the strongest predictor of all-cause mortality, and the single phosphorus measure was the weakest predictor. Associations between serum phosphorus and adverse outcomes were generally stronger for CV death and MACE than for all-cause mortality [Table]. Conclusion As seen in HD patients, this analysis demonstrates that serum phosphorus is a strong predictor of adverse outcomes in patients on PD. When considering serial measurements of serum phosphorus, rates of adverse events began to rise at phosphorus levels &gt;4.5 mg/dL. As recommended by KDIGO guidelines, serial measurements that consider a history of serum phosphorus excursions &gt;4.5 mg/dL should be considered when assessing risks of adverse outcomes.

scholarly journals The Associations of Uric Acid, Cardiovascular and All-Cause Mortality in Peritoneal Dialysis Patients

PLoS ONE ◽  
2014 ◽  
Vol 9 (1) ◽  
pp. e82342 ◽  
Author(s):  
Jie Dong ◽  
Qing-Feng Han ◽  
Tong-Ying Zhu ◽  
Ye-Ping Ren ◽  
Jiang-Hua Chen ◽  
...  
Keyword(s):  
Uric Acid ◽  
Peritoneal Dialysis ◽  
Dialysis Patients ◽  
All Cause Mortality
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