Previous Comorbidity and Lack of Patient Free Choice of Technique Predict Early Mortality in Peritoneal Dialysis

Abstract

Objective To study the prognostic factors for mortality and hospital admission for patients on peritoneal dialysis (PD). Method Biannual data on individual characteristics, clinical and analytical progress, treatment, and events were studied for a cohort of incident patients undergoing PD (2003-2006) in a reference area of 8.8 million people. Results 489 patients (age 53.58 years, 61.6% male) with 3-year follow-up were included. They presented at inclusion with Charlson Comorbidity Index (CCI) of 5.25; previous cardiovascular (CV) event, 23.7%; diabetes mellitus (DM), 19.1%; and hypertension (HT), 89.9%. Annual hospitalization rate per patient-year at risk was 0.6. The variables that predicted admission were CCI [odds ratio (OR) 1.14 per point], DM (OR 1.66), and previous CV event (OR 1.90). Anemia maintained significance when corrected for CCI: hemoglobin, 0.79 per 1 g/dL Hb; CCI, 1.15 per point. Annual mortality rate was 5.4%. Those that died were older (67.47 vs 52.78 years) and had a higher CCI (8.35 vs 5.0), a lower initial Hb (11.5 vs 12.2 g/dL), a higher hospital admission rate, a higher annual rate of peritonitis, more previous CV events (50.0% vs 22.1%), and higher prevalence of DM (38.5% vs 17.9%). Survival analysis identified the following prognostic factors: CCI [hazard ratio (HR) 1.51 per point], CV event (HR 2.85), DM (HR 2.52), age (HR 1.06 per year), and mandatory referral to PD (HR 6.54). The effect of CV events and DM persisted after correction for age, and that of choice of technique after correcting for CCI and/or age. Conclusions The CCI is useful for risk estimation in PD patients. Previous CV event, DM, and age are the most relevant risk factors. Control of anemia has prognostic value for hospital admissions. Mandatory referral to PD is associated with higher mortality. The prognosis in PD depends on predialysis patient management.

The economic considerations of patients and caregivers in choice of dialysis modality

“…It is, therefore, important to ensure that patients still have a choice of treatment, as forcing patients to choose home dialysis would not be successful and may result in increased overall costs and exacerbate treatment inequity. [24][25][26] Chronic conditions impose significant economic hardship to patients. [27][28][29] Economic hardship is exacerbated by ineligibility for government support, health service inflexibility, and low health literacy and may lead to patients not being able to effectively choose or engage in self-management.…”

Predicting One-Year Mortality in Peritoneal Dialysis Patients: An Analysis of the China Peritoneal Dialysis Registry

“…Few studies have been performed evaluating PD patients. Most previous studies only reported a list of prognostic factors 15 , 16 , 18 , 23 - 25 and comorbidities 26 - 28 . We established a prognostic model of short-term mortality using common clinical factors associated with the prognosis of PD.…”

Patient selection and training for home hemodialysis

“…Patients who lack control over modality selection have worse outcomes, probably due to resistance to training and nonadherence to treatment. 7,8 Those who are less motivated, therefore, are likely to require extra training to successfully make the transition to home HD.…”