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. 2017 Jun;36(2):182-191.
doi: 10.23876/j.krcp.2017.36.2.182. Epub 2017 Jun 30.

Relationship between trajectories of serum albumin levels and technique failure according to diabetic status in peritoneal dialysis patients: A joint modeling approach

Mehri Khoshhali  1   2 , Iraj Kazemi  3 , S Mohsen Hosseini  2 , Shiva Seirafian  4
Affiliations

Relationship between trajectories of serum albumin levels and technique failure according to diabetic status in peritoneal dialysis patients: A joint modeling approach

Mehri Khoshhali et al. Kidney Res Clin Pract. 2017 Jun.

Abstract

Background: In peritoneal dialysis, technique failure is an important metric to be considered. This study was performed in order to identify the relationship between trajectories of serum albumin levels and peritoneal dialysis technique failure on end-stage renal disease patients according to diabetic status. Furthermore, this study was performed to reveal predictors of serum albumin and technique failure simultaneously.

Methods: This retrospective cohort study included 300 (189 non-diabetic and 111 diabetic) end-stage renal disease patients on continuous ambulatory peritoneal dialysis treated in Al-Zahra Hospital, Isfahan, Iran, from May 2005 to March 2015. Bayesian joint modeling was carried out in order to determine the relationship between trajectories of serum albumin levels and peritoneal dialysis technique failure in the patients according to diabetic status. Death from all causes was considered as a competing risk.

Results: Using joint modeling approach, a relationship between trajectories of serum albumin with hazard of transfer to hemodialysis was estimated as -0.720 (95% confidence interval [CI], -0.971 to -0.472) for diabetic and -0.784 (95% CI, -0.963 to -0.587) for non-diabetic patients. From our findings it was showed that predictors of low serum albumin over time were time on peritoneal dialysis for diabetic patients and increase in age and time on peritoneal dialysis, history of previous hemodialysis, and lower body mass index in non-diabetic patients.

Conclusion: The results of current study showed that controlling serum albumin over time in non-diabetic and diabetic patients undergoing continuous ambulatory peritoneal dialysis treatment can decrease risk of adverse outcomes during the peritoneal dialysis period.

Keywords: Joint modeling; Peritoneal dialysis; Serum albumin; Technique failure.

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Conflict of interest statement

Conflicts of interest All authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1. Trajectory plot for serum albumin levels (g/dL)
(A) Non-diabetic peritoneal dialysis (PD) patients, (B) diabetic PD patients.
Figure 2
Figure 2. Kaplan-Meier survival plots for peritoneal dialysis failure (A) and death from all causes (B)
The solid and dashed lines depict the survival curves for non-diabetic and diabetic patients, respectively.
See this image and copyright information in PMC

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