Abstract | BACKGROUND: Residual renal function (RRF) is pivotal to long-term outcomes, while rapid RRF decline (RRFD) is associated with mortality risk for continuous ambulatory peritoneal dialysis ( CAPD) patients. This study was conducted to compare the impact of "initial anuria" and rapid RRFD on the long-term prognosis of CAPD patients. METHOD: According to the timing of anuria and the slope of RRFD, a total of 255 incident CAPD patients were divided into 3 groups. For the " anuria" group, anuria was detected from CAPD initiation and persisted for > 6 months (n = 27). Based on the median of the RRFD slope, the other 228 non-anuric patients were divided into a "slow decliner" group (n = 114), and a "rapid decliner" group (n = 114). The maximal observation period was 120 months. RESULTS: Logistic regression tests indicated that the " anuria" group was associated with previous hemodialysis > 3 months (odds ratio [OR]: 8.52, 95% confidence interval [CI]: 3.12 - 23.28), and female (OR: 0.29, 95% CI: 0.09 - 0.90), while the "fast decliner" group with higher Davies co-morbidity scores (DCS) (OR: 1.52; 95% CI: 1.08 - 2.14), body mass index (BMI) (OR: 1.12; 95% CI: 1.04 - 1.21), and male (OR: 1.12; 95% CI: 1.04 - 1.21). After adjusting for DCS, the "fast decliner" group (hazard ratio [HR]: 0.37; 95% CI: 0.17 - 0.80) showed a better outcome than that of the " anuria" group (reference = 1). Both baseline RRF (β = -0.24; p < 0.001) and DCS (β = -3.76; p < 0.001) showed inverse linear correlations to the slope of RRFD. From the Cox proportional analyses, higher baseline RRF (HR: 0.92; 95% CI: 0.88 -.97) and higher slope of RRFD (slower decline in RRF) (HR: 0.90; 95% CI: 0.85 - 0.96) were independent factors for less mortality risk in patients with DCS = 0. However, only a higher slope of RRFD (HR: 0.97; 95% CI: 0.94 - 0.99) was significant for better survival in CAPD patients with DCS > 0. CONCLUSION: Compared to the baseline RRF, CAPD patients with co-morbidities that rapidly deteriorate RRFD are more crucially associated with long-term mortality risk.
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Authors | Yi-Hua Lu, Jyh-Chang Hwang, Ming-Yan Jiang, Charn-Ting Wang |
Journal | Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis
(Perit Dial Int)
2015 Mar-Apr
Vol. 35
Issue 2
Pg. 172-9
ISSN: 1718-4304 [Electronic] United States |
PMID | 24711636
(Publication Type: Journal Article)
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Copyright | Copyright © 2015 International Society for Peritoneal Dialysis. |
Topics |
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Anuria
(diagnosis, etiology, therapy)
- Child
- Cohort Studies
- Female
- Glomerular Filtration Rate
- Humans
- Kidney Failure, Chronic
(complications, physiopathology, therapy)
- Logistic Models
- Male
- Middle Aged
- Peritoneal Dialysis, Continuous Ambulatory
- Time Factors
- Treatment Outcome
- Young Adult
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