Publication: Prognostic factors of all-cause mortalities in continuous ambulatory peritoneal dialysis: a cohort study
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Issued Date
2013
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eng
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Mahidol University
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BioMed Central
Bibliographic Citation
BMC Nephrology. Vol. 14, (2013), 28
Suggested Citation
Phisitt Vejakama, Ammarin Thakkinstian, Atiporn Ingsathit, Prateep Dhanakijcharoen, Attia, John Prognostic factors of all-cause mortalities in continuous ambulatory peritoneal dialysis: a cohort study. BMC Nephrology. Vol. 14, (2013), 28. doi:10.1186/1471-2369-14-28 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/2695
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Title
Prognostic factors of all-cause mortalities in continuous ambulatory peritoneal dialysis: a cohort study
Abstract
Background: The role of small solute clearance on mortalities in patients with CAPD has been controversial. We
therefore conducted a study with 3 years' follow up in adult patients who participated in the CAPD-first policy.
Methods: There were 11,523 patients with end-stage renal disease who participated in the CAPD-first policy
between 2008 and 2011. Among them, 1,177 patients were included in the retrospective cohort study. A receiver
operating characteristic curve was applied to calibrate the cutoffs of tKt/V, rKt/V and tCrcl. Kaplan-Meier and
Cox-regression models with time varying covariates were applied to estimate overall death rate, probability of
death and prognosis, respectively.
Results: The cutoffs of rKt/V and tKt/V were 0.25 and 1.75, respectively. The Cox regression suggested that the
higher these clearance parameters, the lower the risks of death after adjusting for covariables. The risks of death for
those above these cutoffs were 57% (HR = 0.43, 95% CI: 0.31, 0.60) and 29% (HR = 0.71, 95% CI: 0.52, 0.98) lower for
rKt/V and tKt/V, respectively. Age, serum albumin, hemoglobin, systolic blood pressure, and ultra-filtration volume
significantly affected the mortality outcome.
Conclusions: Our study suggested that the cutoffs of 0.25 and 1.75 for rKt/V and tKt/V might be associated with
mortality in CAPD patients. A minimum tKt/V of 1.75 should be targeted, but increased dialysis dosage to achieve
tKt/V > 2.19 adds no further benefit. Serum albumin, hemoglobin, SBP, and UF volume are also associated with
mortality. However, our study may face with selection and other unobserved confounders, so further randomized
controlled trials are required to confirm these cutoffs.