Dialysis vintage and cardiovascular injury as factors influencing long-term survival in peritoneal dialysis and hemodialysis

Dialysate glucose response phenotypes during peritoneal equilibration test and their association with cardiovascular death: A cohort study

Different measures of rates of transfer of glucose during the peritoneal equilibrium test (PET), undertaken during peritoneal dialysis (PD) might provide additional information regarding a patient's risk of future cardiovascular mortality. This study aimed to characterize the heterogeneity of dialysate glucose (DG) response phenotypes during the PET and compare the cardiovascular mortality rates associated with the different phenotypes. Our cohort was derived from Henan peritoneal dialysis registry. A total of 3477 patients initiating PD in 2007 to 2014 had the DG measured at 0, 2-hour and 4-hour (D0, D2, and D4 respectively) during the PET for estimation of D2/D0 and D4/D0. Deaths mainly due to CVD within 2 years since the initiation of PD were defined as the outcome. Latent class mixed-effect models were fitted to identify distinct phenotypes of the DG response during the PET. Multivariable unconditional Logistic regression models with adjustment for cardiometabolic risk factors were used to compare the 2-year risk of cardiovascular mortality among patients in the different latent classes. Three distinct DG response phenotypes during the PET were identified. Those with consistently high D2/D0 and D4/D0 ratios had a 1.22 [95% confidence interval: 1.02, 1.35] excess risk of a cardiovascular death within 2 years of commencing PD compared with patients with the lowest D2/D0 ratio and decreased D4/D0 ratio after adjustment for cardiometabolic risk factors. Consistently elevated D2/D0 and D4/D0 ratios during the PET are associated with an increased risk of 2-year cardiovascular mortality independent of other cardiometabolic risk factors. In view of the potential bias due to unmeasured confounders (eg, Family history of cardiovascular diseases, and dietary patterns), this association should be further validated in other external cohorts.

Is dialysis vintage a perioperative risk for end-stage renal disease patients receiving total knee and hip arthroplasty

BACKGROUND

End-stage renal disease is an independent risk factor for postoperative mortality and cardiovascular events, but dialysis vintage and its relationship with perioperative complication is not well studied. We did a population-based study to investigate this issue.

MATERIALS AND METHODS

We identified patients who had total knee arthroplasty (TKA) or total hip arthroplasty (THA) surgeries during 1999-2010 from the National Health Insurance Research Database of Taiwan. Patients who had regular dialysis before surgery were recruited in our analysis. The outcome of interest was mortality, morbidities, intensive care unit admission rate, hospitalization duration, readmission rate, and medical costs. We did multivariate regression to adjust for age, sex, and Charlson comorbidity index (CCI) and to analyze the relationship of dialysis vintage and clinical outcomes.

RESULTS

A total of 518 patients were enrolled for analysis. A total of 286 patients had TKA surgeries and 232 patients had THA surgeries. Patients who had TKA surgery were older and had more medical comorbidities than patients who had THA. After adjustment for age, sex, and CCI, TKA patients who had dialysis vintage <3 years had significantly higher medical costs ( p < 0.05). For THA patients, dialysis vintage is not an independent risk factor for outcomes of interest.

CONCLUSION

Perioperative complication is associated with age and medical comorbidities. Longer dialysis vintage is not related to perioperative morbidities and mortalities or higher medical costs in either TKA or THA patients.

The comparison of risk of stroke in patients with peritoneal dialysis and hemodialysis: A systematic review and meta-analysis

OBJECTIVE

Several studies have demonstrated that end-stage renal disease (ESRD) patients on dialysis are at higher risk for cerebrovascular events, especially those on hemodialysis. However, the risk of stroke in patients on peritoneal dialysis (PD) compared to those on hemodialysis (HD) remains unclear. We performed this meta-analysis to assess the risks of stroke in ESRD patients on PD compared to HD.

METHODS

A systematic review was conducted using MEDLINE, EMBASE, Cochrane databases from inception through January 2018 to identify studies that evaluated the risks of stroke (all types of stroke, ischemic stroke or hemorrhagic stroke) in ESRD patients on different dialysis modalities. Effect estimates from the individual study were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird.

RESULTS

Fifteen cohort studies with a total of 1 289 572 ESRD patients (over 1 140 942 on HD and 122 534 on PD) were enrolled. Compared with HD, PD was associated with a significantly decreased risk of hemorrhagic stroke with pooled OR of 0.84 (95% CI: 0.76-0.92). However, there were no differences in risks of all types of stroke or ischemic stroke in those on PD compared to HD with pooled ORs of 1.06 (95% CI: 0.91-1.22) and 1.01 (95% CI: 0.80-1.18,), respectively.

CONCLUSIONS

PD status is associated with 16% lower risk of hemorrhagic stroke compared to HD, but the risks of all types of stroke and hemorrhagic stroke are not statistically different in PD patients when compared to HD patients.

Dialysate Creatinine Response Patterns During Peritoneal Equilibration Test and the Association Between Cardiovascular Mortality: Findings from a Prospective Cohort Study

BACKGROUND/AIMS

During peritoneal equilibrium test (PET), intermediate measures of Dt/P (dialysate/plasma creatinine ratio), D0/P, D2/P and D4/P ratios might provide additional information regarding a patient's cardiovascular mortality. We aimed to characterise heterogeneity of dialysate creatinine response patterns based on three ratios and compare cardiovascular mortality risks by response patterns.

METHODS

3,477 patients initialising peritoneal dialysis (PD) between 2007-2015 were measured D0/P, D2/P and D4/P at baseline and 2-year cardiovascular mortality was defined as the primary outcome. Latent class mixed-effect models were fitted to identify distinct patterns of dialysate creatinine response. Multivariable Logistic regression model with adjustment of cardiometabolic factors were used to compare cardiovascular mortality by latent classes.

RESULTS

The 1st latent class including 36% of participants was characterised by consistently increasing and high Dt/P ratios both at 2-hour and 4-hour. The 2nd class including 61% of participants characterised by sharply increased ratio at 2-hour and slightly increased ratio at 4-hour. The 3rd class included 3% of participants with decreased ratio at 2-hour and increased ratio at 4-hour. Comparing the 1st class, the lower cardiovascular mortality risk was identified in the 2nd and 3rd class with adjusted odds ratio 0.65 (95% confidence interval: 0.62-0.69) and 0.48 (0.41-0.57), respectively.

CONCLUSION

Patients with decreased Dt/P ratio between 0-hour and 2-hour and low ratios at 2-hour and 4-hour tend to have low cardiovascular mortality. Latent class analysis seems to be a promising method to reveal unidentified subgroups that do not fit into the risk category defined by Dt/P ratio at 4-hour.