Association between initial high peritoneal transport property and prognosis of patients undergoing peritoneal dialysis_West China Medical Journal

Authors：

JIANG Jing ,  ZHONG Hui , QIN Min , ZHOU Xueli , HE Xueqin , PU Li , FU Ping

Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

ZHONG Hui, Email: zhonghui39@126.com

Keywords：

Peritoneal dialysis; Peritoneal transport characteristics; Survival; Risk factor

DOI：

10.7507/1002-0179.201905150

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objectives To explore the association between initial peritoneal transport characteristics and patient survival, and to evaluate the risk factors for mortality of continuous ambulatory peritoneal dialysis (CAPD) patients.Methods Between January 2011 and December 2016, the patients diagnosed with end stage renal disease commencing CAPD in West China Hospital were enrolled. According to the value of dialysate to plasma ratio for creatinine at 4 hour [D/P Cr (4 h)], CAPD patients were divided into two groups: the lower transport group [D/P Cr (4 h)<0.65] and the higher transport group [D/P Cr (4 h)≥0.65]. The survival of these two groups of peritoneal dialysis patients were plotted using survival analysis. CAPD patient outcomes were analyzed using multivariable Cox proportional hazards regression models.Results Compared with the lower transporter (n=246), higher transporter (n=345) were older, and with more peritoneal protein loss, lower level of serum albumin, lower level of hemoglobin, and less ultrafiltration (P<0.001). Higher transport group had lower survival rate compared to those in the lower transport group (P=0.001). The 1-, 3- and 5-year patient survival rates were 97.0%, 83.2%, and 71.7% in the higher transport group, and 98.7%, 93.9%, and 86.1% in the lower transport group, respectively. There was a positive relationship between D/P Cr (4 h) and serum peritoneal protein loss (P<0.001). D/P Cr (4 h) was inversely related to serum albumin (P<0.001). Cox regression analysis demonstrated that lower albumin [hazard ratio (HR)=0.921, 95% CI (0.885, 0.958), P<0.001], presence of cardiovascular disease [HR=1.996, 95% CI (1.256, 3.173), P=0.003], elder age [HR=1.049, 95% CI (1.033, 1.065), P<0.001], lower hemoglobin [HR=0.988, 95% CI (0.976, 1.000), P=0.044] and lower urea clearance index (KT/V)[HR=0.680, 95%CI (0.465, 0.994), P=0.046] could independently predicted mortality with significance in CAPD patients. But higher peritoneal transport was not a risk factor for mortality [HR=1.388, 95%CI (0.829, 2.322), P=0.212] in either model including serum albumin.Conclusions For CAPD patients, initial higher transporter had a higher mortality than lower transporter. However, initial higher peritoneal transport was not a risk factor for mortality independent of serum albumin in CAPD patients. Relationship between D/P Cr (4 h) and serum peritoneal protein loss and serum albumin suggests that higher peritoneal transport characteristics might worsen prognosis by lowering serum albumin level at initiation of peritoneal dialysis.

Citation： JIANG Jing, ZHONG Hui, QIN Min, ZHOU Xueli, HE Xueqin, PU Li, FU Ping. Association between initial high peritoneal transport property and prognosis of patients undergoing peritoneal dialysis. West China Medical Journal, 2019, 34(7): 752-758. doi: 10.7507/1002-0179.201905150 Copy

1.	Churchill DN, Thorpe KE, Nolph KD, et al. Increased peritoneal membrane transport is associated with decreased patient and technique survival for continuous peritoneal dialysis patients. The Canada-USA (CANUSA) Peritoneal Dialysis Study Group. J Am Soc Nephrol, 1998, 9(7): 1285-1292.
2.	Davies SJ, Phillips L, Russell GI. Peritoneal solute transport predicts survival on CAPD independently of residual renal function. Nephrol Dial Transplant, 1998, 13(4): 962-968.
3.	Fried L. Higher membrane permeability predicts poorer patient survival. Perit Dial Int, 1997, 17(4): 387-389.
4.	Brimble KS, Walker M, Margetts PJ, et al. Meta-analysis: peritoneal membrane transport, mortality, and technique failure in peritoneal dialysis. J Am Soc Nephrol, 2006, 17(9): 2591-2598.
5.	Park HC, Kang SW, Choi KH, et al. Clinical outcome in continuous ambulatory peritoneal dialysis patients is not influenced by high peritoneal transport status. Perit Dial Int, 2001, 21(Suppl 3): S80-S85.
6.	Huang N, Chen J, Fan L, et al. High peritoneal transport status was not associated with mortality in peritoneal dialysis patients with diabetes. PLoS One, 2014, 9(10): e110445.
7.	Chung SH, Chu WS, Lee HA, et al. Peritoneal transport characteristics, comorbid diseases and survival in CAPD patients. Perit Dial Int, 2000, 20(5): 541-547.
8.	Paniagua R, Amato D, Vonesh E, et al. Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis: ADEMEX, a prospective, randomized, controlled trial. J Am Soc Nephrol, 2002, 13(5): 1307-1320.
9.	Lee CC, Chen KH, Tian YC, et al. Initial high peritoneal transport status is not a predictor of mortality in peritoneal dialysis patients. Ren Fail, 2010, 32(7): 788-795.
10.	Twardowski Z, Nolph K, Khanna R. Peritoneal equilibration test. Perit Dial Bull, 1987, 7(3): 138-147.
11.	Zhang F, Liu H, Gong X, et al. Risk factors for mortality in Chinese patients on continuous ambulatory peritoneal dialysis. Perit Dial Int, 2015, 35(2): 199-205.
12.	Wang H, Tian J, Du F, et al. Effect of peritoneal transport characteristics on clinical outcome in nondiabetic and diabetic nephropathy patients with peritoneal dialysis. Iran J Kidney Dis, 2019, 13(1): 56-66.
13.	Rajaeefard A, Sarvandian S, Rezaianzadeh A, et al. Analyzing the long-term survival of the patients undergoing peritoneal dialysis in the peritoneal dialysis center in Shiraz, 2002-2011. Saudi J Kidney Dis Transpl, 2016, 27(6): 1211-1216.
14.	Rumpsfeld M, McDonald SP, Johnson DW. Peritoneal small solute clearance is nonlinearly related to patient survival in the Australian and New Zealand peritoneal dialysis patient populations. Perit Dial Int, 2009, 29(6): 637-646.
15.	Li S, Foley RN, Collins AJ. Anemia, hospitalization, and mortality in patients receiving peritoneal dialysis in the United States. Kidney Int, 2004, 65(5): 1864-1869.
16.	Fried L, Hebah N, Finkelstein F, et al. Association of Kt/V and creatinine clearance with outcomes in anuric peritoneal dialysis patients. Am J Kidney Dis, 2008, 52(6): 1122-1130.
17.	Abe M, Hamano T, Hoshino J, et al. Predictors of outcomes in patients on peritoneal dialysis: a 2-year nationwide cohort study. Sci Rep, 2019, 9(1): 3967.
18.	Breborowicz A, Oreopoulos DG. Evidence for the presence of chronic inflammation during peritoneal dialysis: therapeutic implications. Perit Dial Int, 1997, 17(Suppl 2): S37-S41.
19.	Chung SH, Heimbürger O, Stenvinkel P, et al. Association between residual renal function, inflammation and patient survival in new peritoneal dialysis patients. Nephrol Dial Transplant, 2003, 18(3): 590-597.
20.	Allawi AAD. Malnutrition, inflamation and atherosclerosis (MIA syndrome) in patients with end stage renal disease on maintenance hemodialysis (a single centre experience). Diabetes Metab Syndr, 2018, 12(2): 91-97.
21.	Szeto CC, Law MC, Wong TY, et al. Peritoneal transport status correlates with morbidity but not longitudinal change of nutritional status of continuous ambulatory peritoneal dialysis patients: a 2-year prospective study. Am J Kidney Dis, 2001, 37(2): 329-336.
22.	Tang Y, Zhong H, Diao Y, et al. Peritoneal transport rate, systemic inflammation, and residual renal function determine peritoneal protein clearance in continuous ambulatory peritoneal dialysis patients. Int Urol Nephrol, 2014, 46(11): 2215-2219.
23.	Unal A, Sipahioglu MH, Kocyigit I, et al. Risk factor(s) related to high membrane permeability in peritoneal dialysis. Ren Fail, 2016, 38(2): 238-241.

1. Churchill DN, Thorpe KE, Nolph KD, et al. Increased peritoneal membrane transport is associated with decreased patient and technique survival for continuous peritoneal dialysis patients. The Canada-USA (CANUSA) Peritoneal Dialysis Study Group. J Am Soc Nephrol, 1998, 9(7): 1285-1292.
2. Davies SJ, Phillips L, Russell GI. Peritoneal solute transport predicts survival on CAPD independently of residual renal function. Nephrol Dial Transplant, 1998, 13(4): 962-968.
3. Fried L. Higher membrane permeability predicts poorer patient survival. Perit Dial Int, 1997, 17(4): 387-389.
4. Brimble KS, Walker M, Margetts PJ, et al. Meta-analysis: peritoneal membrane transport, mortality, and technique failure in peritoneal dialysis. J Am Soc Nephrol, 2006, 17(9): 2591-2598.
5. Park HC, Kang SW, Choi KH, et al. Clinical outcome in continuous ambulatory peritoneal dialysis patients is not influenced by high peritoneal transport status. Perit Dial Int, 2001, 21(Suppl 3): S80-S85.
6. Huang N, Chen J, Fan L, et al. High peritoneal transport status was not associated with mortality in peritoneal dialysis patients with diabetes. PLoS One, 2014, 9(10): e110445.
7. Chung SH, Chu WS, Lee HA, et al. Peritoneal transport characteristics, comorbid diseases and survival in CAPD patients. Perit Dial Int, 2000, 20(5): 541-547.
8. Paniagua R, Amato D, Vonesh E, et al. Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis: ADEMEX, a prospective, randomized, controlled trial. J Am Soc Nephrol, 2002, 13(5): 1307-1320.
9. Lee CC, Chen KH, Tian YC, et al. Initial high peritoneal transport status is not a predictor of mortality in peritoneal dialysis patients. Ren Fail, 2010, 32(7): 788-795.
10. Twardowski Z, Nolph K, Khanna R. Peritoneal equilibration test. Perit Dial Bull, 1987, 7(3): 138-147.
11. Zhang F, Liu H, Gong X, et al. Risk factors for mortality in Chinese patients on continuous ambulatory peritoneal dialysis. Perit Dial Int, 2015, 35(2): 199-205.
12. Wang H, Tian J, Du F, et al. Effect of peritoneal transport characteristics on clinical outcome in nondiabetic and diabetic nephropathy patients with peritoneal dialysis. Iran J Kidney Dis, 2019, 13(1): 56-66.
13. Rajaeefard A, Sarvandian S, Rezaianzadeh A, et al. Analyzing the long-term survival of the patients undergoing peritoneal dialysis in the peritoneal dialysis center in Shiraz, 2002-2011. Saudi J Kidney Dis Transpl, 2016, 27(6): 1211-1216.
14. Rumpsfeld M, McDonald SP, Johnson DW. Peritoneal small solute clearance is nonlinearly related to patient survival in the Australian and New Zealand peritoneal dialysis patient populations. Perit Dial Int, 2009, 29(6): 637-646.
15. Li S, Foley RN, Collins AJ. Anemia, hospitalization, and mortality in patients receiving peritoneal dialysis in the United States. Kidney Int, 2004, 65(5): 1864-1869.
16. Fried L, Hebah N, Finkelstein F, et al. Association of Kt/V and creatinine clearance with outcomes in anuric peritoneal dialysis patients. Am J Kidney Dis, 2008, 52(6): 1122-1130.
17. Abe M, Hamano T, Hoshino J, et al. Predictors of outcomes in patients on peritoneal dialysis: a 2-year nationwide cohort study. Sci Rep, 2019, 9(1): 3967.
18. Breborowicz A, Oreopoulos DG. Evidence for the presence of chronic inflammation during peritoneal dialysis: therapeutic implications. Perit Dial Int, 1997, 17(Suppl 2): S37-S41.
19. Chung SH, Heimbürger O, Stenvinkel P, et al. Association between residual renal function, inflammation and patient survival in new peritoneal dialysis patients. Nephrol Dial Transplant, 2003, 18(3): 590-597.
20. Allawi AAD. Malnutrition, inflamation and atherosclerosis (MIA syndrome) in patients with end stage renal disease on maintenance hemodialysis (a single centre experience). Diabetes Metab Syndr, 2018, 12(2): 91-97.
21. Szeto CC, Law MC, Wong TY, et al. Peritoneal transport status correlates with morbidity but not longitudinal change of nutritional status of continuous ambulatory peritoneal dialysis patients: a 2-year prospective study. Am J Kidney Dis, 2001, 37(2): 329-336.
22. Tang Y, Zhong H, Diao Y, et al. Peritoneal transport rate, systemic inflammation, and residual renal function determine peritoneal protein clearance in continuous ambulatory peritoneal dialysis patients. Int Urol Nephrol, 2014, 46(11): 2215-2219.
23. Unal A, Sipahioglu MH, Kocyigit I, et al. Risk factor(s) related to high membrane permeability in peritoneal dialysis. Ren Fail, 2016, 38(2): 238-241.

West China Medical Journal

Association between initial high peritoneal transport property and prognosis of patients undergoing peritoneal dialysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content