Chunyan Yi

Prevalence and Risk Factors of Fluid Overload in Southern Chinese Continuous Ambulatory Peritoneal Dialysis Patients

Background Fluid overload is frequently present in CAPD patients and one of important predictors of mortality. The aim of this study is to investigate the prevalence and associated risk factors in a cohort study of Southern Chinese CAPD patients. Methods The patients (receiving CAPD 3 months and more) in our center were investigated from January 1, 2008 to December 31, 2009. Multi-frequency bioelectrical impedance analysis was used to assess the patient’s body composition and fluid status. Results A total of 307 CAPD patients (43% male, mean age 47.8±15.3 years) were enrolled, with a median duration of PD 14.6 (5.9–30.9) months. Fluid overload (defined by Extracellular water/Total body water (ECW/TBW)≥0.40) was present in 205 (66.8%) patients. Univariate analysis indicated that ECW/TBW were inversely associated with body mass index (r = −0.11, P = 0.047), subjective global assessment score (r = −0.11, P = 0.004), body fat mass (r = −0.15, P = 0.05), serum albumin (r = −0.32, P<0.001), creatinine (r = −0.14, P = 0.02), potassium (r = −0.15, P = 0.02), and residual urine output (r = −0.14, P = 0.01), positively associated with age (r = 0.27, P<0.001), Chalrlson Comorbidity Index score (r = 0.29, P<0.001), and systolic blood pressure (r = 0.22, P<0.001). Multivariate linear regression showed that lower serum albumin (β = −0.223, P<0.001), lower body fat mass (β = −0.166, P = 0.033), old age (β = 0.268, P<0.001), higher systolic blood pressure (β = 0.16, P = 0.006), less residual urine output (β = −0.116, P = 0.042), and lower serum potassium (β = −0.126, P = 0.03) were independently associated with higher ECW/TBW. After 1 year of follow-up, the cardiac event rate was significantly higher in the patients with fluid overload (17.1% vs 6.9%, P = 0.023) than that of the normal hydrated patients. Conclusions The prevalence of fluid overload was high in CAPD patients. Fluid overload in CAPD patients were independently associated with protein-energy wasting, old age, and decreased residual urine output. Furthermore, CAPD patients with fluid overload had higher cardiac event rate than that of normal hydrated patents.

Clinical outcome and risk factors for mortality in Chinese patients with diabetes on peritoneal dialysis: a 5-year clinical cohort study.

AIMS We evaluated clinical outcome and risk factors affecting survival in patients with diabetes on continuous ambulatory peritoneal dialysis (CAPD) in Southern China. METHODS This longitudinal cohort study enrolled all incident patients who used CAPD as their first renal replacement therapy modality in our center from January 2006 to December 2009 and who were followed until December 2011. Clinical outcomes were compared and risk factors for mortality in patients with diabetes were analyzed. RESULTS Of 809 incident CAPD patients, 189 (23.4%) had diabetes. Death-censored technique survival showed no significant difference between patients with and without diabetes (p=0.271). The 1-, 2-, 3- and 5-year patient survival rates were 90%, 72%, 63% and 36% in patients with diabetes and 95%, 92%, 87% and 73% in patients without diabetes, respectively (p=0.000). Presence of cardiovascular disease (CVD) [hazard ratio (HR) 2.130, 95% confidence interval (CI) 1.199-3.786, p=0.010], advanced age (HR 1.042, 95% CI 1.008-1.078, p=0.014), higher glycated hemoglobin (HR 1.309, 95% CI 1.045-1.640, p=0.019), lower hemoglobin (HR 0.978, 95% CI 0.964-0.992, p=0.003) and lower serum albumin (HR 0.924, 95% CI 0.876-0.976, p=0.004) at the initiation of CAPD were independent risk factors of mortality in CAPD patients with diabetes. CONCLUSIONS Technique survival in CAPD patients with diabetes was similar to those without diabetes. Although patients with diabetes had higher risk of mortality, the patient survival in our study seems to be improved compared with most other reports. Older age, presence of CVD, hyperglycemia, anemia and hypoalbuminemia at the commencement of CAPD affected survival in patients with diabetes.

Risk factors for the first episode of peritonitis in Southern Chinese continuous ambulatory peritoneal dialysis patients.

Background The first episode of peritonitis affects survival of the peritoneal membrane as a medium for dialysis as well as survival of patients. The aim of this study is to investigate risk factors associated with the first episode of peritonitis in Southern Chinese continuous ambulatory peritoneal dialysis (CAPD) patients. Methods This is a single-center, retrospective, cohort study. All incident CAPD patients from 1 January 2006 to 31 December 2010 were recruited, and followed up until their first episode of peritonitis or 31 December, 2012. Baseline demographic, socioeconomic, clinical and laboratory data were collected. Cox proportional model was used to determine the factors associated with the first episode of peritonitis. Results In a cumulative 30756.5 patient-months follow-up (the median vintage 26.1 months) of 1117 CAPD patients, 309(27.7%) patients presented the first episodes of peritonitis. The cumulative peritonitis-free survival was 86.2%, 78.1%, 71.4% and 57.8% at 1, 2, 3 and 5 year, respectively. The multivariate analysis showed that factors associated with risk for the first episode of peritonitis were elderly patients (>65 years) [hazard ratio (HR) = 1.427, 95% confidence interval (CI) = 1.051 to 1.938, P = 0.023], male(HR = 1.315, 95% CI = 1.028 to 1.684, P = 0.030), lower education level (HR = 1.446, 95% CI: 1.127 to 1.855, P = 0.004) and albumin <38g/L (HR = 1.425, 95% CI: 1.112 to 1.825, P = 0.005). Conclusions Older age, male, lower educational level and hypoalbuminemia at the commencement of PD were the risk factors associated with the first episode of peritonitis in Southern Chinese CAPD patients.

Escherichia coli Peritonitis in Peritoneal Dialysis: The Prevalence, Antibiotic Resistance and Clinical Outcomes in a South China Dialysis Center

♦ Introduction: Escherichia coli (E. coli) peritonitis is a frequent, serious complication of peritoneal dialysis (PD). The extended-spectrum β-lactamase (ESBL)-producing E. coli peritonitis is associated with poorer prognosis and its incidence has been on continuous increase during the last decades. However, the clinical course and outcomes of E. coli peritonitis remain largely unclear. ♦ Methods: All of the E. coli peritonitis episodes that occurred in our dialysis unit from 2006 to 2011 were reviewed. The polymicrobial episodes were excluded. ♦ Results: In total, ninety episodes of monomicrobial E. coli peritonitis occurred in 68 individuals, corresponding to a rate of 0.027 episodes per patient-year. E. coli was the leading cause (59.2%) of monomicrobial gram-negative peritonitis. ESBL-producing strains accounted for 35.5% of E. coli peritonitis. The complete cure rate and treatment failure rate of E. coli peritonitis were 77.8% and 10.0% respectively. Patients with preceding peritonitis had a higher risk of ESBL production as compared to those without peritonitis history [odds ratio (OR): 5.286; 95% confidence interval (CI): 2.018 - 13.843; p = 0.001]. The risk of treatment failure was significantly increased when the patient had a baseline score of Charlson Comorbidity Index (CCI) above 3 (OR: 6.155; 95% CI: 1.198 - 31.612; p = 0.03), or had diabetes mellitus (OR: 8.457; 95% CI: 1.838 - 38.91; p = 0.006), or hypoalbuminemia (≤ 30g/l) on admission (OR: 13.714; 95% CI: 1.602 - 117.428; p = 0.01). Prolonging the treatment course from 2 to 3 weeks or more reduced the risk of relapse and repeat significantly (p < 0.05). ♦ Conclusions: E. coli peritonitis remains a common complication of PD. The clinical outcomes of E. coli peritonitis are relatively favorable despite the high ESBL rate. A history of peritonitis is associated with increased risk for ESBL development. The severity of baseline comorbidities, the presence of diabetes mellitus and hypoalbuminemia at admission are associated with poor outcomes.

The Effect of Fluid Overload on Clinical Outcome in Southern Chinese Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

♦ Background: Fluid overload is frequently present in dialysis patients and one of the important predictors of patient outcome. This study aimed to investigate the influence of fluid overload on all-cause mortality and technique failure in Southern Chinese continuous ambulatory peritoneal dialysis (CAPD) patients. ♦ Methods: This was a post hoc study from a cross-sectional survey originally designed to investigate the prevalence and associated risk factors of fluid overload defined by bioimpedance analysis (BIA) in CAPD patients from January 1, 2008, to December 31, 2009. All 307 CAPD patients completing the original study were followed up until December 31, 2012. ♦ Results: With a median follow-up period of 38.4 (19.2 – 47.9) months, 52 patients died. Patients with fluid overload (defined by extracellular water/total body water [ECW/TBW] ≥ 0.40) had a significantly higher peritonitis rate (0.016 vs 0.011 events/month exposure, p = 0.018) and cerebrovascular event rate (3.9 vs 1.1 events/100 patient years, p = 0.024) than the normal hydrated patients. Moreover, the results showed a significant rising of all-cause mortality (log-rank test = 5.59, p = 0.018), and a trend of increasing cardiovascular disease (CVD) mortality (log-rank test = 2.90, p = 0.089) and technique failure (log-rank test = 3.78, p = 0.052) in the patients with fluid overload. Fluid overload independently predicted all-cause mortality (hazard ratio [HR] = 12.98, 95%, confidence interval [CI] = 1.06 – 168.23, p = 0.042) and technique failure (HR = 13.56, 95% CI = 2.53 – 78.69, p = 0.007) in CAPD patients after adjustment for confounders. ♦ Conclusions: Fluid overload defined by BIA was an independent predictor for all-cause mortality and technique failure in CAPD patients. Continuous ambulatory peritoneal dialysis patients with fluid overload had a higher peritonitis rate, cardiovascular event rate, and poorer clinical outcome than those patients with normal hydration.

Clinical outcomes in elderly patients on chronic peritoneal dialysis: a retrospective study from a single center in china.

♦ Objectives: We aimed to evaluate clinical outcomes and identify the predictors of mortality in elderly patients undergoing continuous ambulatory peritoneal dialysis (CAPD). ♦ Methods: This retrospective cohort study included all incident CAPD patients treated at our center from 2006 to 2009. Demographic and clinical data on initiation of CAPD and clinical events during the study period were collected. Survival probabilities were generated using the Kaplan-Meier method, and risk factors for mortality were evaluated using Cox proportional hazards models. ♦ Results: Of 805 patients on CAPD, the elderly group (≥65 years; mean age: 71.3 ± 4.3 years) consisted of 148 patients, and the younger group (<65 years; mean age: 43.1 ± 12.2years) consisted of 657 patients. The 1-, 2-, 3-, and 5-year patient survival rates were 97%, 92%, 88%, and 73% for the younger group, and 79%, 67%, 56%, and 30% for elderly group. The patient survival rates were significantly lower for the elderly group than for the younger group (p = 0.000). However, technique survival did not significantly differ between the groups (p = 0.559). In the patients overall, the independent predictors of death were old age (p = 0.003), diabetes (p = 0.000), cardiovascular disease (p = 0.006), lower hemoglobin (p = 0.010), and lower serum albumin (p = 0.024). Mortality in the elderly patients was associated with advanced age [relative risk (RR): 1.088; 95% confidence interval (CI): 1.027 to 1.153; p = 0.004], diabetes (RR: 2.064; 95% CI: 1.236 to 3.445; p = 0.006), and lower serum albumin (RR: 0.940; 95% CI: 0.897 to 0.985; p = 0.010). ♦ Conclusions: The elderly patients on CAPD experienced technique survival comparable with that of younger patients, but their patient survival was lower. In elderly patients, mortality was determined predominantly by greater age, diabetes, and lower serum albumin. Our results indicate that chronic peritoneal dialysis is a viable dialysis option for elderly patients with end-stage renal disease. Better management of hypoalbuminemia and comorbid conditions might improve survival in elderly PD patients.

Clinical Outcomes of Remote Peritoneal Dialysis Patients: A Retrospective Cohort Study from a Single Center in China

Background/Aims: To investigate clinical outcomes of remote peritoneal dialysis (PD) patients in Southern China. Methods: In this retrospective cohort study, incident remote PD patients managed with a comprehensive follow-up program in our PD center were included and clinical outcomes were estimated. Results: One thousand and five remote PD patients with mean age 46.1 ± 14.6 years, of which 38.1% were women, were followed-up for a median of 35.7 months. Patient survival rates were 95.4, 84.7 and 71.8% and death-censored technique survival rates were 98.6, 92.3 and 83.4% at 1, 3 and 5 years, respectively. Peritonitis rate was 0.16 episodes per patient-year. Advanced age, diabetes mellitus, shorter peritonitis-free survival time, poor compliance for regular visiting nephrologists and lower hemoglobin predicted all-cause mortality of remote PD patients. Conclusion: The remote PD patients in Southern China managed with comprehensive follow-up program had favorable clinical outcomes, which indicated that home-based PD therapy could be an appropriate treatment option for remote end-stage kidney disease patients.

Platelet index levels and cardiovascular mortality in incident peritoneal dialysis patients: a cohort study

Abstract Prior studies have shown that the levels of some platelet (PLT) indices were associated with mortality in patients undergoing hemodialysis. We aimed to investigate whether the changes in PLT indices associated with mortality in patients on peritoneal dialysis (PD). A single-center, retrospective observational cohort study was conducted in incident PD patients from 1 January 2006 to 31 December 2012, and followed up until 31 December 2014. Cox proportional hazard models were used to examine the relationships between the levels of PLT indices including PLT, plateletcrit (PCT), mean platelet volume (MPV), platelet distribution width (PDW), platelet large cell ratio (PLCR), and mortality. Of 1324 patients, 276 (20.8%) died during follow-up (median, 37; IQR, 3–107.4 months), among which 134 were due to cardiovascular diseases (CVD). The highest tertile of PLT levels at baseline was associated with increased risk for cardiovascular mortality after adjustment for demographic, clinical characteristics, and laboratory variables (hazard ratio [HR]:1.93; 95% confidence interval [CI]: 1.16–3.20). The similar treads were also observed in the middle and the highest tertile of the PCT level (HR: 1.68, 95%CI: 1.00–2.81 and HR: 1.89, 95%CI: 1.14–3.14, respectively). In addition, the highest tertile of PCT was associated with increased all-cause mortality (HR: 1.41, 95%CI: 1.01–1.96). However, none of the associations in MPV, PDW, and PLCR analyses reached statistical significance (HR: 0.71, 95%CI: 0.43–1.16; HR: 0.72, 95%CI: 0.45–1.18 and HR: 0.74, 95%CI: 0.46–1.19, respectively). These results suggest that higher PLT and PCT may be associated with higher risk for cardiovascular mortality in incident PD patients. Additional studies are needed to investigate whether correction of these two PLT indices reduces the risk.

Baseline higher peritoneal transport had been associated with worse nutritional status of incident continuous ambulatory peritoneal dialysis patients in Southern China: a 1-year prospective study.

The aim of the present study was to investigate the relationship between baseline peritoneal transport types and nutritional status in Chinese continuous ambulatory peritoneal dialysis (CAPD) patients. In the present single-centre, prospective study, incident CAPD patients were included from 15 April 2010 to 31 December 2011 and were followed up for 12 months. According to the results of baseline peritoneal equilibration test, patients were divided into lower peritoneal transport group (lower transporters) and higher peritoneal transport group (higher transporters). Nutritional status was evaluated by both subjective global assessment (SGA) and protein-energy wasting (PEW) score. The body composition parameters were assessed by body impedance analysis. A total of 283 CAPD patients were included in the study, of which 171 (60.4 %) were males with a mean age of 47.0 (sd 14.9) years. Compared with lower transporters (n 92), higher transporters (n 181) had lower levels of serum albumin (37.1 (sd 4.3) v. 39.6 (sd 4.3) g/l, P< 0.001), serum pre-albumin (356 (sd 99) v. 384 (sd 90) mg/l, P= 0.035), phase angle (6.15 (sd 0.39) v. 6.27 (sd 0.47)°, P< 0.05) and higher rate of malnutrition defined by SGA (52.5 v. 25.0%, P< 0.001) and PEW score (37.0 v. 14.1 %, P< 0.001) at 1-year of follow-up. Baseline higher peritoneal transport, analysed by multivariate binary logistic regressions, was independently associated with malnutrition (SGA mild to moderate and severe malnutrition: OR 3.43, 95% CI 1.69, 6.96, P< 0.01; PEW: OR 2.40, 95% CI 1.08, 5.31, P= 0.03). It was concluded that baseline higher peritoneal transport was independently associated with worse nutritional status of CAPD patients in Southern China.

Gender-specific associations of skeletal muscle mass and arterial stiffness among peritoneal dialysis patients

Decreased skeletal muscle has been identified as a relevant factor for arterial stiffness but has not been thoroughly investigated in peritoneal dialysis (PD) patients. The aim of this study was to investigate the relationship between skeletal muscle and arterial stiffness in PD patients. A cross-sectional study of 658 prevalent PD patients with a mean brachial-ankle pulse wave velocity (baPWV) of 1714 (±501) cm/s and mean skeletal muscle mass of 26.6 (±5.4) kg was performed. Skeletal muscle mass level was significantly higher in males than in females. When examining skeletal muscle mass as a continuous variable, skeletal muscle mass was significantly associated with baPWV in fully adjusted linear regression models in total patients [standardized coefficients (β), −0.181; 95% confidence interval (95% CI), −0.276 to −0.056; P = 0.003] or female patients (β, −0.119; 95% CI, −0.350 to −0.015; P = 0.03) but not in male patients (β, −0.117; 95% CI, −0.300 to 0.011; P = 0.07). Furthermore, in females, a significant association between the middle or highest tertile of skeletal muscle mass and baPWV was found in fully adjusted models (β, −0.123; 95% CI, −0.204 to −0.008; P = 0.03; β, −0.140; 95% CI, −0.228 to −0.016; P = 0.02, respectively). In conclusion, decreased skeletal muscle mass was independently associated with increased baPWV in PD patients, and this association was significant in females but not in males.