scholarly journals Impact of diuresis and number of exchanges on Continuous Ambulatory Peritoneal Dialysis related peritonitis risk in RDPLF registry.

2020 ◽  
Vol 3 (2) ◽  
pp. 83-92
Author(s):  
Clément Vachey ◽  
Caroline Roubiou ◽  
Catherine Bresson-Vautrin ◽  
Cécile Courivaud
Keyword(s):  
Risk Factor ◽  
Peritoneal Dialysis ◽  
Kidney Transplantation ◽  
Competing Risks ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Lower Risk ◽  
Diabetic Patients ◽  
Increased Risk ◽  
The Mean ◽  
The Impact

Introduction Peritonitis is still a frequent complication among patients undergoing peritoneal dialysis (PD) and it’s associated with a significant morbimortality. The aim of our study was to investigate the impact of diuresis volume and number of exchanges (NE) on continuous ambulatory peritoneal dialysis (CAPD) related peritonitis risk. Methods This study was performed with data from the French peritoneal dialysis registry (RDPLF). We included every incident patient in the registry from January 2010 to November 2019 who had at least an adequacy evaluation. Peritonitis risk was assessed firstly by estimating a peritonitis rate per year undergoing PD and secondly by focusing on time to first peritonitis, taking into account competing risks (kidney transplantation, switch to hemodialysis, PD withdrawal whatever the cause or death). Patients whose diuresis was <500mL/24 hours were considered oliguric. Results We included 620 patients in our analysis. The mean age was 72,9 (standard deviation (SD)=15,1). Two hundred and six (39,55%) had at least one peritonitis episode. No difference was observed between oliguric patients and the others. However, we noticed an increased risk in patients with a NE≥22 per week (HR=1,55, P=0,0005 and HR=1,47, P=0,02 considering competing risks). We also observed a lower risk in diabetic patients HR=0,74, p=0,02 and HR=0,77, p=0,0497). Conclusion We didn’t find any impact of diuresis volume on peritonitis risk. Whereas, the NE seems to be a considerable risk factor, especially when it’s superior to 22 per week.

Evaluation of glycerol as an osmotic agent for continuous ambulatory peritoneal dialysis in end-stage renal failure

1986 ◽  
Vol 70 (1) ◽  
pp. 23-29 ◽  
Author(s):  
A. Heaton ◽  
M. K. Ward ◽  
D. G. Johnston ◽  
K. G. M. M. Alberti ◽  
D. N. S. Kerr
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Fluid Balance ◽  
Serum Insulin ◽  
Control Period ◽  
Density Lipoprotein ◽  
Diabetic Patients ◽  
High Concentration ◽  
Osmotic Agent ◽  
The Mean

1. Six patients established on continuous ambulatory peritoneal dialysis entered a trial of treatment with dialysis fluid containing glycerol instead of glucose as the osmotic agent in an attempt to decrease the energy load. They were observed for a further 6 months after reconversion to glucose-based dialysis. 2. During the 6 month control period fluid balance was achieved mainly with a solution containing 76 mmol of glucose/l. Fluid balance was maintained during the 6 month period of treatment with glycerol only by the increased use of solutions containing a high concentration of glycerol (152 mmol/l and 272 mmol/l). Thus the energy value of the absorbed osmotic agent did not differ at a mean of 1607 kJ (384 kcal)/day using glycerol and 1669 kJ (399 kcal)/day using glucose as the osmotic agent. 3. In five subjects, fasting and peak blood glycerol levels did not change over the 6 months, but one subject, who accumulated glycerol, developed symptoms of hyperosmolality after 2 months and glycerol therapy was discontinued. In a further subject glycerol-based dialysis was terminated at 3 months when increasing angina was reported. 4. Mean fasting plasma triglyceride concentrations were 50% higher during the 6 months on glycerol (3.12 ± 1.12 mmol/l) than on glucose (2.19 ± 0.97 mmol/l) (P < 0.05). There was a small rise in very low density lipoprotein-cholesterol concentrations with glycerol dialysis but total cholesterol levels were unchanged. 5. The absorption of glycerol was not associated with an acute rise in circulating glucose or insulin but the mean blood glucose, over a 6 h dialysis cycle, had risen by 0.5 mmol/l after 3 months' treatment with glycerol and the mean serum insulin had risen from 5.9 ± 0.7 m-units/l to 9.8 ± 0.6 m-units/l (P < 0.01). 6. This study demonstrated no substantial advantage of glycerol over glucose as an osmotic agent in non-diabetic patients on continuous ambulatory peritoneal dialysis.

scholarly journals The impact of aspirin on Klebsiella pneumoniae liver abscess in diabetic patients

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Chien-Hsiang Tai ◽  
Chien-Ning Hsu ◽  
Shih-Cheng Yang ◽  
Cheng-Kun Wu ◽  
Chih-Ming Liang ◽  
...  
Keyword(s):  
Propensity Score ◽  
Klebsiella Pneumoniae ◽  
Liver Abscess ◽  
Lower Risk ◽  
Pyogenic Liver Abscess ◽  
Rank Test ◽  
Diabetic Patients ◽  
H2 Blockers ◽  
Increased Risk ◽  
The Impact

AbstractIn this study, we aimed to investigate the impact of aspirin on the risk of pyogenic liver abscess caused by Klebsiella pneumoniae (KP-PLA) and invasive KP-PLA syndrome (IKPS) in diabetic patients. Diabetic patients who were propensity-score matched were retrospectively included from hospital-based database. Kaplan–Meier approach with a log-rank test was used to compare the cumulative incidences of KP-PLA including IKPS between aspirin users and non-users. Totally, 63,500 patients were analyzed after propensity-score matching (1:1). Compared with that of non-users, the incidence of KP-PLA was significantly reduced in aspirin users (0.31% vs. 0.50%, p < 0.01), but not for that of IKPS (0.02% vs. 0.03%, p = 0.29). Patients taking aspirin for ≥ 90 days had a significantly lower risk for KP-PLA (hazard ratio, 0.67; 95%CI, 0.50–0.90). Females, taking clopidogrel or metformin for ≥ 90 days, and taking H2-blockers or proton pump inhibitors (PPIs) for ≥ 5 days were also associated with a lower risk of KP-PLA. However, cholangitis and a glycated hemoglobin ≥ 8.5% were associated with an increased risk of KP-PLA.

Neuropathy and Quality of Life in Diabetic Continuous Ambulatory Peritoneal Dialysis Patients

1999 ◽  
Vol 19 (2_suppl) ◽  
pp. 242-247 ◽  
Author(s):  
Theofanis Apostolou ◽  
Ram Gokal
Keyword(s):  
Quality Of Life ◽  
At Risk ◽  
Peritoneal Dialysis ◽  
Autonomic Neuropathy ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Diabetic Patients ◽  
Number Of Patients ◽  
End Stage ◽  
The Impact

Oiabetes mellitus is the commonest cause of end-stage renal failure and is associated with considerable morbidity. Neuropathy is one of the most serious complications of diabetes, linked to the incidence of nephropathy and retinopathy. The prevalence of neuropathy increases with age and duration of diabetes. Peripheral sensorimotor neuropathy is the main manifestation of neurological dam -age in diabetes, while autonomic neuropathy, a devastating complication, is also present in a large number of patients with long-term diabetes. Clinical features of autonomic neuropathy are mainly cardiovascular disorders and abnormal visceral function. One of the most important sequelae of neuropathy is the development of the insensitive foot at risk of ulceration, deformation, Charcot neuroarthropathy, and amputation. Prevention, education, and identification of the at-risk patient are the key elements in managing these severe complications. Oialysis, and mainly peritoneal dialysis, still remains the main renal replacement therapy for end-stage renal disease (ESRO) diabetic patients. It is obvious from many studies that diabetes and its complications are major risk factors associated with poorer survival rates, increased morbidity, and decreased quality of life. Few, if any, data are available specifically evaluating quality of life in continuous ambulatory peritoneal dialysis (CAPO) diabetic patients. Fewer data are available estimating the impact of neuropathy on the quality of life of such patients. Specific studies must be carried out to further investigate quality-of-life issues and neuropathy in this vulnerable group of patients.

scholarly journals MO699PERITONITIS RISK OF PD MODALITIES AND TECHNICAL SURVIVAL ACCORDING TO BASELINE PERITONEAL TRANSPORT STATUS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Hasan Haci Yeter ◽  
Omer Faruk Akcay ◽  
Galip Güz
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Peritoneal Dialysis ◽  
Survival Rates ◽  
Significant Risk ◽  
Technical Failure ◽  
Peritoneal Transport ◽  
The Mean ◽  
The Impact

Abstract Background and Aims The PD modality is usually modulated according to the PET and dialysis adequacy during follow-up but, initial modality choice generally depends on patient preferences and lifestyle regardless of patients’ baseline transport status. However, the relationship between baseline transport status, the PD modality chosen, and technical survival is not well established. Peritonitis is one of the leading causes of technical failure, hospitalization, and death in PD. While obesity, low albumin levels, exit-site infections, and nasal staphylococcus carriage are well-defined risk factors for peritonitis, some suggest CAPD could be another risk factor due to increased daily connection to PD. Many studies indicated that CAPD and APD have similar technical survival rates. In this study, we aimed to identify the impact of the baseline transport status on technical survival of CAPD and APD. We also investigated peritonitis risk of modalities considering all defined risk factors. Method This is a retrospective, single-center, cohort study of incident adult PD patients followed-up between January 2010 and January 2020. One hundred and thirty-six patients, followed-up for at least three years, were included. Patients with malignancy and who had less than 1.7 Kt/V per week were excluded. Peritonitis is defined according to the "International Society Peritoneal Dialysis" guideline. According to the baseline PET, patients were divided into two groups as follows; 1) high or high average transporters and 2) low or low average transporters. Risk factors for peritonitis, five years, and overall technical survival of both modalities according to baseline transport status were determined. Results The mean age was 35.5±12 years, and the median follow-up time was 47 (36-178) months. Sixty-six (48%) of the patients were female. Patients' first-year Kt/V per week was 2.18±0.4, and the mean ultrafiltration was 0.9±0.4 liters. 26 (19%) of the patients had diabetes mellitus, 57(42%) patients had hypertension, and 27 (20%) of the patients had a history of hemodialysis of more than three months. 89 (65%) of the patients were performing CAPD, 59 (66%) of whom were low or low-average transporters. 47(35%) of patients were performing APD and 28(60%) of whom were high or high-average transporters. During the follow-up, a total of 71 peritonitis episodes were observed, and the incidence of peritonitis was 0.13 episodes/year. Univariate logistic regression analysis showed that CAPD, low education level (being primary school graduate or illiterate), HD treatment before PD, and bathing less than once per week were associated with peritonitis risk. However, multivariate analysis of associated factors demonstrated that only CAPD was a significant risk factor for peritonitis [odds ratio:2.360 (95% confidence interval:1.075-5.180), p=0.03]. Kaplan-Meier survival analysis showed that low or low-average transporters and high or high-average transporters had similar technical survival rates in both CAPD or APD at the end of three years (figure 1). Similar rates were found in overall survival. Conclusion In our study, APD and CAPD patients had similar technical survival regardless of the peritoneal transport characteristics. However, CAPD was found to be a factor for peritonitis. Thus, it may be appropriate to initiate the PD treatment with APD modality and evaluate patients to switch modalities with PET only in case of peritoneal dialysis inadequacy.

Impact of assistance on peritonitis due to breach in aseptic procedure in diabetic patients: A cohort study with the RDPLF data

2021 ◽  
pp. 089686082110396
Author(s):  
Clémence Béchade ◽  
Antoine Lanot ◽  
Sonia Guillouët ◽  
Maxence Ficheux ◽  
Annabel Boyer ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Peritoneal Dialysis ◽  
Lower Risk ◽  
Self Care ◽  
Bivariate Analysis ◽  
Diabetic Patients ◽  
Subdistribution Hazard ◽  
Family Assistance ◽  
Competing Events ◽  
The Impact

Background: Diabetic patients often have physical impairment that could lead to manipulation errors in peritoneal dialysis (PD) and touch contamination. Nurse assistance in diabetic PD patients is known to help prevent peritonitis. We made the hypothesis that this lower risk of peritonitis was observed thanks to prevention of breach in aseptic procedure. We evaluated the impact of nurse-assisted PD on specific causes of peritonitis, especially on peritonitis due to a breach in aseptic procedure. Methods: This was a retrospective observational study of the data from the French Language Peritoneal Dialysis Registry. All diabetic patients older than age 18 years starting PD in France between 1 January 2012 and 31 December 2015 were included in the study. The event of interest was the first peritonitis event due to a breach in aseptic procedure. Death, kidney transplantation and peritonitis due to another mechanism were considered as competing events. We examined the association of the covariates with all the possible outcomes using a subdistribution hazard model developed for survival analysis in the presence of competing risks. Results: Four thousand one hundred one diabetic patients incident in PD were included in the study. At least one peritonitis event occurred in 1611 patients over the study period. A breach in aseptic procedure was reported in 441/1611 cases (27.3%): 209/575 (36.3%) in the self-care PD group, 56/217 (25.8%) in the family-assisted PD group and 176/819 (21.5%) in the nurse-assisted PD group. Both nurse and family assistance were associated with a lower risk of peritonitis due to breach in aseptic procedure in bivariate analysis. After adjustment on age, modified Charlson index, sex and diabetic nephropathy, patients treated by nurse-assisted PD (subdistribution hazard ratio (sd-HR) 0.52, 95% confidence interval (CI) 0.40–0.67) and those treated by family-assisted PD (sd-HR 0.70, 95% CI 0.51–0.95) had a lower likelihood of peritonitis due to a connection error compared to self-care PD in multivariate analysis. The modality of assistance was not associated with other causes of peritonitis in the multivariate analysis. Conclusion: While both nurse-assisted PD and family-assisted PD were associated with lower risk of peritonitis due to a breach in aseptic procedure compared to self-care PD in our study, the protective effect was greater with nurse assistance.

Comparison of patient survival and technique survival between continuous ambulatory peritoneal dialysis and automated peritoneal dialysis

2020 ◽  
Vol 40 (6) ◽  
pp. 563-572
Author(s):  
I-Kuan Wang ◽  
Tung-Min Yu ◽  
Tzung-Hai Yen ◽  
Shih-Yi Lin ◽  
Chia-Ling Chang ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Lower Risk ◽  
Patient Survival ◽  
Diabetic Patients ◽  
Automated Peritoneal Dialysis ◽  
Technique Survival ◽  
Peritoneal Permeability ◽  
Male Patients ◽  
Technique Failure

Background: This retrospective cohort study compared patient survival and technique survival between patients on continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) using recent data at a single tertiary medical center in Taiwan. Methods: From medical records, we identified incident 459 CAPD patients and 266 APD patients on dialysis for at least 90 days and aged more than 18 years to estimate mortality and technique failure rates, and related hazard ratio (HR) and 95% confidence interval (CI) from 2007 to 2018. Results: There were more women (52.3%) in the CAPD group, whereas patients in the APD group were younger. Compared to CAPD patients, APD patients had a lower mortality rate (2.83 vs. 5.79 per 100 person-years) with an adjusted HR of 0.69 (95% CI = 0.47–1.02), and a lower technique failure rate (9.70 vs. 17.52 per 100 person-years) with an adjusted HR of 0.65 (95% CI = 0.51–0.83). Further subgroup analyses revealed that, compared to CAPD, APD was associated with a significant lower risk of technique failure in male patients, patients aged 50–65 years, diabetic patients, patients without cardiovascular disease (CVD), patients with higher peritoneal permeability, or patients initiating PD in an earlier era. Conclusions: The mortality risk was not significant between CAPD and APD patients. APD is associated with a lower risk of technique failure than CAPD, particularly for male patients, and patients aged 50–65 years, with diabetes, without CVD, with high or high average peritoneal permeability, or initiating PD in an earlier era.

A United Kingdom Multicenter Study of Icodextrin in Continuous Ambulatory Peritoneal Dialysis

1994 ◽  
Vol 14 (2_suppl) ◽  
pp. 22-27 ◽  
Author(s):  
Ram Gokal ◽  
Chandra D. Mistry ◽  
Elizabeth Peers ◽  
C.B. Brown ◽  
S. Smith ◽  
...  
Keyword(s):  
Molecular Weight ◽  
United Kingdom ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Diabetic Patients ◽  
Study Group ◽  
Large Molecular Weight ◽  
Number Of Patients ◽  
The Mean

While glucose remains the only osmotic agent used universally for peritoneal dialysis, its various shortcomings for the long dwell equilibration continuous ambulatory peritoneal dialysis (CAPD) has led to a search for alternative agents. The large molecular weight group has been of interest, because these agents theoretically would lead to greater ultrafiltration and a better metabolic profile. Mostsubstances (dextrans, charged macromolecules) have been found unsuitable for reasons of insolubility, allergenicity, and peritoneal toxicity. Short-chain polypeptides have been studied in humans, but the experience is limited, and there is the potential for allergenicity with long-term use. The only large molecular weight agent that has been studied in some detail but hitherto in one center only and in a limited number of patients is glucose polymer (generic name, icodextrin). Because of the promise shown by these initial studies, a randomized controlled multicenter investigation of icodextrin in CAPD (MIDAS Study Group) was undertaken to evaluate the long-term safety and efficacy by comparing daily overnight (8 12 hours) use of a slightly hypo-osmolar solution (282 mOsm/ kg) with 1.36% (346 mOsm/kg) and 3.86% (484 mOsm/kg) glucose exchanges. Over a 6-month period 209 patients from 11 centers in the United Kingdom were randomized, with 106 allocated to receive icodextrin (study group) and 103 to remain on glucose (control group). One hundred and thirty-eight patients completed the 6-month study (71 control, 67 study). The mean net ultrafiltration overnight with icodextrin was 3.5 times greater than 1.36% at 8 hours and 5.5 times greater at 12 hours (p<0.0001), but no different from that of 3.86% glucose at 8 and 12 hours (although for the latter dwell the net mean ultrafiltration volume was greater by about 140 mL). Biochemical profiles were no different except for a small fall in serum sodium and chloride in the icodextrin group. The mean serum maltose rose to a steady-state level of 1.2 g/L within 2 weeks and remained stable. The mean carbohydrate absorbed for icodextrin (29±5 g) was lower than with 3.86% glucose (62±5 g). The use of icodextrin did not increase the incidence of peritonitis, nor did it alter its outcome, affect uptake of icodextrin from the peritoneum, alter serum osmolality or sodium levels. There were no adverse effects associated with the use of icodextrin, and the overall CAPD-related symptom score was significantly better for icodextrin than control subjects. This study and subsequent extensive use and clinical experience has demonstrated that the daily use of an iso-osmolar icodextrin solution is generally well tolerated, effective, and could replace the overnight use of hyperosmotic glucose solution. Its use was of equal efficacy in peritonitis and in diabetic patients. The elevated levels of maltose did not appear to have any clinical side effects.

scholarly journals Perceived Social Status and Suicidal Ideation in Maltreated Children and Adolescents

2021 ◽  
Author(s):  
Kelli L. Dickerson ◽  
Helen M. Milojevich ◽  
Jodi A. Quas
Keyword(s):  
Risk Factor ◽  
Suicidal Ideation ◽  
Children And Adolescents ◽  
Social Status ◽  
Lower Risk ◽  
Developmental Patterns ◽  
Factors Associated ◽  
Established Risk Factor ◽  
Increased Risk ◽  
Perceived Social Status

AbstractRecent decades have seen an alarming increase in rates of suicide among young people, including children and adolescents (“youth”). Although child maltreatment constitutes a well-established risk factor for suicidal ideation in youth, few efforts have focused on identifying factors associated with maltreated youths’ increased risk for suicidal ideation, especially across development. The present study examined the relations between maltreated youths' (N = 279, M = 12.06 years, 52% female, 53% Latinx) perceptions of their social status and suicidal ideation and compared those relations between pre-adolescents and adolescents. Findings revealed unique developmental patterns: Perceived social status was associated with suicidal ideation, but only in adolescents, who showed greater risk for suicidal ideation if they viewed themselves as lower ranked in society and lower risk for suicidal ideation if they viewed themselves as higher ranked in society. Findings have implications for scientific and practical efforts aimed at better understanding and preventing suicide in a high-risk developmental population.

The effect of insulin pump therapy in retinal vasculature in type 1 diabetic patients

2021 ◽  
pp. 112067212199057
Author(s):  
Tomás de Oliveira Loureiro ◽  
João Nobre Cardoso ◽  
Carlos Diogo Pinheiro Lima Lopes ◽  
Ana Rita Carreira ◽  
Sandra Rodrigues-Barros ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Metabolic Control ◽  
Insulin Pump Therapy ◽  
Vascular Density ◽  
Diabetic Patients ◽  
Retinal Vasculature ◽  
Increased Risk ◽  
The Mean ◽  
Type 1 Diabetic Patients

Background/objectives: Continuous subcutaneous insulin infusion (CSII) is a treatment for type 1 diabetes that improves metabolic control and reduces micro and macrovascular complications. The aim of this study was to compare the effect of CSII versus traditional multiple daily injections (MDI) therapy on retinal vasculature. Methods: We performed a prospective study with type 1 diabetic patients with no prior history of ocular pathology other than mild diabetic retinopathy. The patients were divided into two groups according to their therapeutic modality (CSII vs MDI). The retinal nerve fiber layers thickness and vascular densities were compared between groups in both macula and optic disc. The correlations between vascular density and clinical features were also determined. Statistical significance was defined as p < 0.05. Results: The study included 52 eyes, 28 in the insulin CSII group. The mean age was 36.66 ± 12.97 years, with no difference between groups ( p = 0.49). The mean glycated hemoglobin (HbA1c) was found to be lower in the CSII group (7.1% ± 0.7 vs 7.5% ± 0.7 p < 0.01). The parafoveal vascular density was found to be higher in the CSII group (42.5% ± 0.4 vs 37.7% ± 0.6, p < 0.01). We found an inverse correlation between HbA1c value and parafoveal vascular densities ( p < 0.01, r = −0.50). Conclusion: We found that CSII provided better metabolic control than MDI and this seemed to result in higher parafoveal vascular density. As lower vascular density is associated with an increased risk of diabetic retinopathy, these results suggest that CSII could be the safest therapeutic option to prevent retinopathy.

scholarly journals Insulin Resistance as a Predictor of Cardiovascular Disease in Patients on peritoneal dialysis

2013 ◽  
Vol 33 (4) ◽  
pp. 411-418 ◽  
Author(s):  
Yun Li ◽  
Lihua Zhang ◽  
Yong Gu ◽  
Chuanming Hao ◽  
Tongying Zhu
Keyword(s):  
Insulin Resistance ◽  
Peritoneal Dialysis ◽  
Independent Predictor ◽  
Hazard Ratio ◽  
Diabetic Patients ◽  
Model Assessment ◽  
Mortality Hazard ◽  
Cv Disease ◽  
The Impact ◽  
Mortality Hazard Ratio

BackgroundInsulin resistance is associated with multiple risk factors for cardiovascular (CV) disease in the general population. Patients on peritoneal dialysis (PD) are more likely to develop insulin resistance. However, no evaluation of the impact of insulin resistance on CV disease morbidity or mortality in patients on PD has been performed.MethodsOur prospective cohort study included all non-diabetic patients on PD at our center ( n = 66). Insulin resistance was evaluated at baseline by the homeostasis model assessment method (HOMA-IR) using fasting glucose and insulin levels. The cohort was followed for up to 58 months (median: 41.3 months; interquartile range: 34.3 months). A multivariate Cox model was used to analyze the impact of insulin resistance on CV disease mortality.ResultsFourteen CV events occurred in the higher HOMA-IR group [IR-H (HOMA-IR values in the range 2.85 – 19.5), n = 33], but only one event occurred in the lower HOMA-IR group (IR-L (HOMA-IR values in the range 0.83 – 2.71), n = 33) during the follow-up period. Level of HOMA-IR was a significant predictor of CV events [risk ratio: 17.7; 95% confidence interval (CI): 2.10 to 149.5; p = 0.008]. In the IR-H group, 10 patients died (8 CV events), but in the IR-L group, only 4 patients died (1 CV event). Patients in the IR-H group experienced significantly higher CV mortality (hazard ratio: 9.02; 95% CI: 1.13 to 72.2; p = 0.04). Even after adjustments for age, systolic blood pressure, body mass index, C-reactive protein, triglycerides, resistin, and leptin, HOMA-IR remained an independent predictor of CV mortality (hazard ratio: 14.8; 95% CI: 1.22 to 179.1; p = 0.03).ConclusionsInsulin resistance assessed using HOMA-IR was an independent predictor of CV morbidity and mortality in a cohort of nondiabetic patients on PD. Insulin resistance is a modifiable risk factor; the reduction of insulin resistance may reduce CV risk and improve survival in this group of patients.

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