Exercise Parameters Predict Technique Survival in Patients on Peritoneal Dialysis

Abstract

<b><i>Objective:</i></b> The incremental shuttle walking test (ISWT) is an important marker of aerobic capacity in patients on peritoneal dialysis (PD). This study aimed to evaluate its predictive value for PD-related outcomes. <b><i>Methods:</i></b> This single-center cohort study recruited outpatients on maintenance PD from our hospital between March 2017 and March 2018. Exercise capacity was assessed using measurement of ISWT and handgrip and quadriceps strength. Patients were divided into 2 groups according to the median of exercise capacity and prospectively followed up until cessation of PD, death, or the study end (October 2019). The primary end point of this study was technique survival rate, and secondary outcomes were rates of peritonitis-free survival and PD-related hospitalization-free survival. <b><i>Results:</i></b> Among the 50 participants, age and PD vintage were [median (IQR)] 62.5 (58.3–70) and 3.5 (1.3–6.5) years, respectively. At the end of the study, 3 of the 28 participants (11%) in the long-ISWT group and 13 of the 22 participants (59%) in the short-ISWT group were transferred to hemodialysis. The short-ISWT group showed lower technique survival rate (<i>p</i> < 0.001), peritonitis-free survival rate (<i>p</i> = 0.01), and PD-related hospitalization-free survival rate (<i>p</i> < 0.01) than the long-ISWT group, whereas those survival rates did not differ when participants were divided by handgrip or quadriceps strength. Multivariate analysis revealed lower ISWT to be independently associated with technique failure (<i>p</i> = 0.002). <b><i>Conclusion:</i></b> The ISWT is an important predictor of technique survival for patients on PD. Monitoring and enhancing ISWT as a marker of aerobic capacity might improve PD-related outcomes.

Self‐assessment sheet submission rate predicts technique survival in patients initiating peritoneal dialysis

“…As a result, considering multicollinearity, age, sex, CCI, eGFR, GNRI and submission rate were included as independent variables. [12][13][14][15][16][17] The same variables were selected as candidate covariates for multivariate analysis to assess their association with the secondary outcomes, peritonitis-free survival, HF-related hospitalization-free survival and ESI/TI-free survival. In addition to the standard Cox regression model for cause-specific hazards, the Fine and Grey subdistribution hazard model was used in the multivariate model as a sensitivity analysis for technique survival, 12,17 because death and transplantation were competing risk events against technique failure.…”

“…In addition to the submission rate, variables associated with technique survival, the primary endpoint, were included in the multivariate regression. As a result, considering multicollinearity, age, sex, CCI, eGFR, GNRI and submission rate were included as independent variables 12–17 . The same variables were selected as candidate covariates for multivariate analysis to assess their association with the secondary outcomes, peritonitis‐free survival, HF‐related hospitalization‐free survival and ESI/TI‐free survival.…”

Eosinophilic Reaction at the Time of Catheter Insertion Predicts Survival in Patients Initiating Peritoneal Dialysis

“…In addition to E1W/E0, parameters that were previously shown to be associated with technique survival were included in the multivariate regression model. Consequently, taking multicollinearity into consideration, age, sex, CCI, eGFR, GNRI, and E1W/E0 were included as candidate-independent variables [17][18][19][20][21]. For sensitivity analyses, E0 or E1W or both was included as independent variables, instead of E1W/E0.…”

“…Therefore, continuous and extensive efforts are ongoing to identify risk factors of technique failure and to develop potential interventions to improve technique survival. Studies identified older age; male sex; diabetes mellitus; presence of comorbidities; lower residual renal function (RRF); lower nutritional status including lower body mass index, albumin, and GNRI; and lower exercise capacity assessed by the incremental shuttle walking or 6-min walking test as factors independently associated with the higher technique failure rate [17-21, 23, 24]. The present study demonstrated that E1W/E0 as readout for eosinophilic reaction at the time of PD catheter insertion was a novel marker that predicted both the higher technique failure rate and higher peritonitis and HF-related hospitalization rates in patients initiating PD.…”

“…The same variables were selected as potential covariates for multivariate analysis to assess their association with peritonitis-free survival and HF-related hospitalization-free survival. Additionally, as death and transplantation were competing risk events against technique failure, the Fine and Gray subdistribution hazards model was used in the multivariate model as a sensitivity analysis for technique survival, together with the standard Cox regression model for cause-specific hazards [21]. All statistical analyses were performed using SPSS software for Macintosh (version 25; IBM, Armonk, NY, USA).…”