Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
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Regimen-related Mortality Risk in Patients Undergoing Peritoneal Dialysis Using Hypertonic Glucose Solution: A Retrospective Cohort Study

  • Received : 2018.03.12
  • Accepted : 2018.06.11
  • Published : 2018.07.31
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Abstract

Objectives: The main purpose of this study was to quantify the risk of mortality linked to various regimens of hypertonic peritoneal dialysis (PD) solution. Methods: A retrospective cohort study of patients using home-based PD was carried out. The prescribed regimen of glucose-based PD solution for all patients, determined on the basis of their individual conditions, was extracted from their medical chart records. The primary outcome was death. The treatment regimens were categorized into 3 groups according to the type of PD solution used: original PD (1.5% glucose), shuffle PD (1.5 and 2.5% glucose), and serialized PD (2.5 and 4.5% glucose). Multivariate analysis (using the Weibull model) was applied to comprehensively examine survival probabilities related to the explanatory variable, while adjusting for other potential confounders. Results: Of 300 consecutive patients, 38% died over a median follow-up time of 30 months (interquartile range: 15-46 months). Multivariate analysis showed that a treatment regimen with continued higher-strength PD solution (serialized PD) resulted in a lower survival rate than when the conventional strength solution was used (adjusted hazard ratio, 2.6; 95% confidence interval, 1.6 to 4.6, p<0.01). Five interrelated risk factors (age, length of time on PD, hemoglobin levels, albumin levels, and oliguria) were significant predictors contributing to the outcome. Conclusions: Frequent exposure to high levels of glucose PD solution significantly contributed to a 2-fold higher rate of death, especially when hypertonic glucose was prescribed continuously.

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References

  1. Kendrick J, Teitelbaum I. Strategies for improving long-term survival in peritoneal dialysis patients. Clin J Am Soc Nephrol 2010;5(6):1123-1131. https://doi.org/10.2215/CJN.04300709
  2. Mateijsen MA, van der Wal AC, Hendriks PM, Zweers MM, Mulder J, Struijk DG, et al. Vascular and interstitial changes in the peritoneum of CAPD patients with peritoneal sclerosis. Perit Dial Int 1999;19(6):517-525.
  3. Teixeira JP, Combs SA, Teitelbaum I. Peritoneal dialysis: update on patient survival. Clin Nephrol 2015;83(1):1-10. https://doi.org/10.5414/CN108382
  4. Al-Hwiesh AK, Shawarby MA, Abdul-Rahman IS, Al-Oudah N, Al-Dhofairy B, Divino-Filho JC, et al. Changes in peritoneal membrane with different peritoneal dialysis solutions: is there a difference? Hong Kong J Nephrol 2016;19:7-18. https://doi.org/10.1016/j.hkjn.2016.03.001
  5. Wen Y, Guo Q, Yang X, Wu X, Feng S, Tan J, et al. High glucose concentrations in peritoneal dialysate are associated with all-cause and cardiovascular disease mortality in continuous ambulatory peritoneal dialysis patients. Perit Dial Int 2015;35(1): 70-77. https://doi.org/10.3747/pdi.2013.00083
  6. Kadota A, Hozawa A, Okamura T, Kadowak T, Nakmaura K, Murakami Y, et al. Relationship between metabolic risk factor clustering and cardiovascular mortality stratified by high blood glucose and obesity: NIPPON DATA90, 1990-2000. Diabetes Care 2007;30(6):1533-1538. https://doi.org/10.2337/dc06-2074
  7. Mistry CD, Gokal R. Optimal use of glucose polymer (icodextrin) in peritoneal dialysis. Perit Dial Int 1996;16 Suppl 1:S104-S108.
  8. Freida P, Wilkie M, Jenkins S, Dallas F, Issad B. The contribution of combined crystalloid and colloid osmosis to fluid and sodium management in peritoneal dialysis. Kidney Int 2008;73 Suppl 108:S102-S111. https://doi.org/10.1038/sj.ki.5002610
  9. Bonomini M, Pandolfi A, Di Liberato L, Di Silvestre S, Cnops Y, Di Tomo P, et al. L-carnitine is an osmotic agent suitable for peritoneal dialysis. Kidney Int 2011;80(6):645-654. https://doi.org/10.1038/ki.2011.117
  10. Cho Y, Johnson DW, Badve S, Craig JC, Strippoli GF, Wiggins KJ. Impact of icodextrin on clinical outcomes in peritoneal dialysis: a systematic review of randomized controlled trials. Nephrol Dial Transplant 2013;28(7):1899-1907. https://doi.org/10.1093/ndt/gft050
  11. Li PK, Szeto CC, Piraino B, de Arteaga J, Fan S, Figueiredo AE, et al. ISPD peritonitis recommendations: 2016 update on prevention and treatment. Perit Dial Int 2016;36(5):481-508. https://doi.org/10.3747/pdi.2016.00078
  12. Oei E, Fan S. Peritoneal dialysis adequacy in elderly patients. Perit Dial Int 2015;35(6):635-639. https://doi.org/10.3747/pdi.2014.00336
  13. Rocco M, Soucie JM, Pastan S, Mcclellan WM. Peritoneal dialysis adequacy and risk of death. Kidney Int 2000;58(1):446-457. https://doi.org/10.1046/j.1523-1755.2000.00184.x
  14. Jansen MA, Termorshuizen F, Korevaar JC, Dekker FW, Boeschoten E, Krediet RT. Predictors of survival in anuric peritoneal dialysis patients. Kidney Int 2005;68(3):1199-1205. https://doi.org/10.1111/j.1523-1755.2005.00512.x
  15. Munoz de Bustillo E, Borras F, Gomez-Roldan C, Perez-Contreras FJ, Olivares J, Garcia R, et al. Impact of peritonitis on long-term survival of peritoneal dialysis patients. Nefrologia 2011; 31(6):723-732.
  16. Tong J, Liu M, Li H, Luo Z, Zhong X, Huang J, et al. Mortality and associated risk factors in dialysis patients with cardiovascular disease. Kidney Blood Press Res 2016;41(4):479-487. https://doi.org/10.1159/000443449
  17. Wu HY, Hung KY, Huang JW, Chen YM, Tsai TJ, Wu KD. Initial glucose load predicts technique survival in patients on chronic peritoneal dialysis. Am J Nephrol 2008;28(5):765-771. https://doi.org/10.1159/000128608
  18. Schoenfeld DA. Sample-size formula for the proportional-hazards regression model. Biometrics 1983;39(2):499-503. https://doi.org/10.2307/2531021
  19. Schemper M, Smith TL. A note on quantifying follow-up in studies of failure time. Control Clin Trials 1996;17(4):343-346. https://doi.org/10.1016/0197-2456(96)00075-X
  20. Avram MM, Blaustein D, Fein PA, Goel N, Chattopadhyay J, Mittman N. Hemoglobin predicts long-term survival in dialysis patients: a 15-year single-center longitudinal study and a correlation trend between prealbumin and hemoglobin: management of comorbidities in kidney disease in the 21st century: anemia and bone disease. Kidney Int 2003;64 Suppl 87:S6-S11. https://doi.org/10.1046/j.1523-1755.64.s87.3.x
  21. Krediet RT, Lindholm B, Rippe B. Pathophysiology of peritoneal membrane failure. Perit Dial Int 2000;20 Suppl 4:S22-S42.
  22. Davies SJ, Mushahar L, Yu Z, Lambie M. Determinants of peritoneal membrane function over time. Semin Nephrol 2011; 31(2):172-182. https://doi.org/10.1016/j.semnephrol.2011.01.006
  23. Hassan K, Hassan F, Edgem R, Moshe S, Hassan S. The impact of the peritoneal glucose load index on hydration status and inflammation in peritoneal dialysis patients. J Int Med Res 2015;43(1):42-53. https://doi.org/10.1177/0300060514550013
  24. Holmes CJ. Reducing cardiometabolic risk in peritoneal dialysis patients: role of the dialysis solution. J Diabetes Sci Technol 2009;3(6):1472-1480. https://doi.org/10.1177/193229680900300629
  25. Simon F, Tapia P, Armisen R, Echeverria C, Gatica S, Vallejos A, et al. Human peritoneal mesothelial cell death induced by high-glucose hypertonic solution involves Ca2+ and Na+ ions and oxidative stress with the participation of PKC/NOX2 and PI3K/Akt pathways. Front Physiol 2017;8:379. https://doi.org/10.3389/fphys.2017.00379
  26. Kang DH, Hong YS, Lim HJ, Choi JH, Han DS, Yoon KI. High glucose solution and spent dialysate stimulate the synthesis of transforming growth factor-beta1 of human peritoneal mesothelial cells: effect of cytokine costimulation. Perit Dial Int 1999;19(3):221-230.
  27. Krediet RT, Zweers MM, van Westrhenen R, Zegwaard A, Struijk DG. Effects of reducing the lactate and glucose content of PD solutions on the peritoneum. Is the future GLAD? NDT Plus 2008;1(Suppl 4):iv56-iv62.
  28. Lv ZD, Wang HB, Li FN, Wu L, Liu C, Nie G, et al. TGF-${\beta}1$ induces peritoneal fibrosis by activating the Smad2 pathway in mesothelial cells and promotes peritoneal carcinomatosis. Int J Mol Med 2012;29(3):373-379. https://doi.org/10.3892/ijmm.2011.852
  29. Baroni G, Schuinski A, de Moraes TP, Meyer F, Pecoits-Filho R. Inflammation and the peritoneal membrane: causes and impact on structure and function during peritoneal dialysis. Mediators Inflamm 2012;2012:912595.
  30. Selby NM, Fialova J, Burton JO, McIntyre CW. The haemodynamic and metabolic effects of hypertonic-glucose and amino-acid-based peritoneal dialysis fluids. Nephrol Dial Transplant 2007;22(3):870-879. https://doi.org/10.1093/ndt/gfl654
  31. Rumpsfeld M, McDonald SP, Johnson DW. Higher peritoneal transport status is associated with higher mortality and technique failure in the Australian and New Zealand peritoneal dialysis patient populations. J Am Soc Nephrol 2006;17(1):271-278. https://doi.org/10.1681/ASN.2005050566
  32. Krediet RT, Balafa O. Cardiovascular risk in the peritoneal dialysis patient. Nat Rev Nephrol 2010;6(8):451-460. https://doi.org/10.1038/nrneph.2010.68
  33. Li PK, Chow KM. The clinical and epidemiological aspects of vascular mortality in chronic peritoneal dialysis patients. Perit Dial Int 2005;25 Suppl 3:S80-S83.
  34. Korbet S, Rodby R. Causes, diagnosis, and treatment of peritoneal membrane failure. In: Henrich WL, editor. Principles and practice of dialysis. 2nd ed. Baltimore: Williams and Wilkins; 1998, p. 185-206.
  35. Davies SJ, Phillips L, Naish PF, Russell GI. Peritoneal glucose exposure and changes in membrane solute transport with time on peritoneal dialysis. J Am Soc Nephrol 2001;12(5): 1046-1051.
  36. Holmes CJ, Shockley TR. Strategies to reduce glucose exposure in peritoneal dialysis patients. Perit Dial Int 2000;20 Suppl 2:S37-S41.