Higher Peritoneal Protein Clearance as a Risk Factor for Cardiovascular Disease in Peritoneal Dialysis Patient

Chang, Tae Ik; Kang, Ea Wha; Lee, Yong Kyu; Shin, Sug Kyun
February 2013
PLoS ONE;Feb2013, Vol. 8 Issue 2, p1
Academic Journal
Background and Aims: Although a number of studies have been published on peritoneal protein clearance (PrCl) and its association with patient outcomes, the results have been inconsistent. Therefore, the intent of this study was to evaluate the impact of PrCl on cardiovascular disease (CVD) and mortality in peritoneal dialysis (PD) patients. Methods: This prospective observational study included a total of 540 incident patients who started PD at NHIC Ilsan Hospital, Korea from January 2000 to December 2009. Two different types of analyses such as intention-to-treat and as-treated were used. Results: Correlation analyses revealed that PrCl was positively correlated with diabetes, pulse pressure, C–reactive protein (CRP) level, dialysate/plasma creatinine ratio (D/P cr) at 4 h, and peritoneal Kt/V urea. PrCl was inversely correlated with serum albumin and triglyceride levels. On multivariate analysis, serum albumin, pulse pressure, D/P cr at 4 h, and peritoneal Kt/V urea were found to be independent determinants of PrCl. A total of 129 (23.9%) patients in intention-to-treat analysis and 117 (21.7%) patients in as-treated analysis developed new cardiovascular events. Time to occurrence of cardiovascular event was significantly longer in patients with a value of PrCl below the median (89.4 ml/day). In multivariate analysis, older age, presence of diabetes or previous CVD, and higher PrCl were independent predictors of cardiovascular events. Patients above the median value of PrCl had a significantly lower rate of survival than those below the median. However, a higher PrCl was not associated with increased mortality in multivariate Cox analysis. Conclusions: A higher PrCl is a risk for occurrence of cardiovascular event, but not mortality in PD patients. Large randomized clinical trials are warranted to confirm this finding.


Related Articles

  • Long-term mortality and cardiovascular risk stratification of peritoneal dialysis patients using a combination of inflammation and calcification markers. Wang, Angela Yee-Moon; Lam, Christopher Wai-Kei; Chan, Iris Hiu-Shuen; Sanderson, John E.; Mei Wang; Siu-Fai Lui // Nephrology Dialysis Transplantation;Dec2009, Vol. 24 Issue 12, p3826 

    Background. It remains unknown whether a composite of inflammation and calcification markers provides better mortality and cardiovascular risk stratification in chronic peritoneal dialysis (PD) patients.

  • Better Understanding of Bariatric Surgery Outcomes Through Sleep. Tufik, Sergio; Berro, Laís; Andersen, Monica // Obesity Surgery;Nov2014, Vol. 24 Issue 11, p1999 

    A letter to the editor is presented in response to the article "Cardiovascular risk profile in Mediterranean patients submitted to bariatric surgery and intensive lifestyle intervention: impact of both interventions after 1 year of follow-up," by P. Sanchis and colleagues in the 2014 issue.

  • Seasonal variation in peritoneal dialysis-associated peritonitis: a multi-centre registry study. Cho, Yeoungjee; Badve, Sunil V.; Hawley, Carmel M.; McDonald, Stephen P.; Brown, Fiona G.; Boudville, Neil; Wiggins, Kathryn J.; Bannister, Kym M.; Clayton, Philip A.; Johnson, David W. // Nephrology Dialysis Transplantation;May2012, Vol. 27 Issue 5, p2028 

    Background. The role of seasonal variation in peritoneal dialysis (PD)-related peritonitis has been limited to a few small single-centre studies. Methods. Using all 6610 Australian patients receiving PD between 1 October 2003 and 31 December 2008, we evaluated the influence of seasons on...

  • Long-term outcome of encapsulating peritoneal sclerosis (EPS) patients in a single center. Yamahatsu, Aya; Hamada, Chieko; Kaneko, Kayo; Io, Hiroaki; Nakata, Junichiro; Tomino, Yasuhiko // Clinical & Experimental Nephrology;Oct2015, Vol. 19 Issue 5, p961 

    Background: Encapsulating peritoneal sclerosis (EPS) is the most serious complication of peritoneal dialysis (PD) with a high mortality rate. The objective of the present study was to determine the clinical characteristics, the incidence rate, and the long-term outcome of EPS patients compared...

  • Automated Peritoneal Dialysis Is Associated with Better Survival Rates Compared to Continuous Ambulatory Peritoneal Dialysis: A Propensity Score Matching Analysis. Beduschi, Gabriela de Carvalho; Figueiredo, Ana Elizabeth; Olandoski, Marcia; Pecoits-Filho, Roberto; Barretti, Pasqual; Moraes, Thyago Proenca de; null, null // PLoS ONE;7/27/2015, Vol. 10 Issue 7, p1 

    Introduction: The impact of peritoneal dialysis modality on patient survival and peritonitis rates is not fully understood, and no large-scale randomized clinical trial (RCT) is available. In the absence of a RCT, the use of an advanced matching procedure to reduce selection bias in large...

  • Hyponatremia Predicts New-Onset Cardiovascular Events in Peritoneal Dialysis Patients. Kim, Hyung Woo; Ryu, Geun Woo; Park, Cheol Ho; Kang, Ea Wha; Park, Jung Tak; Han, Seung Hyeok; Yoo, Tae-Hyun; Shin, Sug Kyun; Kang, Shin-Wook; Choi, Kyu Hun; Han, Dae Suk; Chang, Tae Ik // PLoS ONE;Jun2015, Vol. 10 Issue 6, p1 

    Background and Aim: Cardiovascular (CV) disease is the leading cause of morbidity and mortality in patients on peritoneal dialysis (PD). Hyponatremia was recently shown to be a modifiable factor that is strongly associated with increased mortality in PD patients. However, the clinical impact of...

  • Transition between home dialysis modalities: another piece in the jigsaw of the integrated care pathway. Lambie, Mark; Davies, Simon J. // Nephrology Dialysis Transplantation;Nov2015, Vol. 30 Issue 11, p1781 

    No abstract available.

  • Outcomes of integrated home dialysis care: a multi-centre, multi-national registry study. Nadeau-Fredette, Annie-Claire; Chan, Christopher T.; Yeoungjee Cho; Hawley, Carmel M.; Pascoe, Elaine M.; Clayton, Philip A.; Polkinghorne, Kevan R.; Boudville, Neil; Leblanc, Martine; Johnson, David W. // Nephrology Dialysis Transplantation;Nov2015, Vol. 30 Issue 11, p1897 

    Background. The 'integrated home dialysis' model involving initiation of peritoneal dialysis (PD) first followed by home haemodialysis (HHD) has previously been proposed as an optimal form of dialysis that maximizes the advantages of both modalities. While this model has great potential, its...

  • The Definition of Metabolically Healthy Obesity. Hae Kyung Yang; Seung-Hwan Lee // Journal of Korean Diabetes;2014, Vol. 15 Issue 1, p17 

    Metabolically healthy obesity (MHO) is a term indicating a subgroup of obese individuals who demonstrate normal to high levels of insulin sensitivity, a lower level of visceral adiposity and more favorable cardiovascular risk profiles. Although identifying MHO might have clinical significance in...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics