Risk factors for mortality in Chinese patients on continuous ambulatory peritoneal dialysis

Abstract

Objective: The intent of this study was to evaluate the clinical outcome and risk factors affecting mortality of the continuous ambulatory peritoneal dialysis (CAPD) patients in a single peritoneal dialysis (PD) center over a period of 10 years.

Patients and methods: We retrospectively analyzed patients on PD from June 2001 to June 2011. The clinical and biochemical data were collected from the medical records. Clinical variables included gender, age at the start of PD, smoking status, body mass index (BMI), cause of end-stage renal disease (ESRD), presence of diabetes mellitus and blood pressure. Biochemical variables included hemoglobin, urine volume, residual renal function (RRF), serum albumin, blood urea nitrogen (BUN), creatinine, total cholesterol, triglyceride, comorbidities, and outcomes. Survival curves were made by the Kaplan-Meier method. Univariate and multivariate analyses to identify mortality risk factors were performed using the Cox proportional hazard regression model.

Results: A total of 421 patients were enrolled, 269 of whom were male (63.9%). The mean age at the start of PD was 57.9 ± 14.8 years. Chronic glomerulonephritis was the most common cause of ESRD (39.4%). Estimation of patient survival by Kaplan-Meier was 92.5%, 80.2%, 74.4%, and 55.7% at 1, 3, 5, and 10 years, respectively. Patient survival was associated with age (hazard ratio [HR]: 1.641 [1.027 - 2.622], p = 0.038), cardiovascular disease (HR: 1.731 [1.08 - 2.774], p = 0.023), hypertriglyceridemia (HR: 1.782 [1.11 - 2.858], p = 0.017) in the Cox proportional hazards model analysis. Estimation of technique survival by Kaplan-Meier was 86.7%, 68.8%, 55.7%, and 37.4% at 1, 3, 5, and 10 years, respectively. In the Cox proportional hazards model analysis, age (HR: 1.672 [1.176 - 2.377], p = 0.004) and hypertriglyceridemia (HR: 1.511 [1.050 - 2.174], p = 0.026) predicted technique failure.

Conclusion: The PD patients in our center exhibited comparable or even superior patient survival and technical survival rates, compared with reports from other centers in China and other countries.

Keywords: Clinical outcome; Cox proportional hazards model; dialysis patients; mortality; patient survival; peritoneal dialysis; risk factors; technique survival.

Figure 1 —

(A) Patient survival and (B) technique survival analysis of PD patients. PD = peritoneal dialysis.