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Prognostic Value of Predialysis Indices for Technique Failure and Mortality in Peritoneal Dialysis Patients
Author(s) -
Matsui Masaru,
Akai Yasuhiro,
Samejima Kenichi,
Tsushima Hideo,
Tanabe Kaori,
Morimoto Katsuhiko,
Tagawa Miho,
Saito Yoshihiko
Publication year - 2017
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/1744-9987.12546
Subject(s) - medicine , peritoneal dialysis , hemodialysis , odds ratio , anemia , body mass index , dialysis , multivariate analysis , confidence interval , surgery , gastroenterology
Technique failure remains a frequent cause of peritoneal dialysis (PD) withdrawal. Many post‐commencement predictors of PD technique failure have been identified, while predialysis predictors have remained unclear. The aim of this study was to identify predialysis indices for technique failure in PD patients. We recruited 206 consecutive PD patients who were treated at Nara Medical University Hospital between 1 April 1997 and 31 December 2012. Forty‐eight patients were excluded because of transition from hemodialysis (HD) or withdrawal from PD within 3 months, leaving 158 patients for analysis. Clinical characteristics and laboratory data from within 3 months preceding PD commencement were analyzed. The primary outcome was the composite of time to combined use of HD, transition to HD, and all‐cause mortality within 2 years after PD commencement. During the study period, the primary outcome was observed in 50 patients. Using multivariate analysis, greater age (odds ratios (ORs) [95%CI], 3.08 [1.72–5.61]), anemia (ORs [95%CI], 2.12 [1.08–4.43]), overweight/obesity (ORs [95%CI], 2.09 [1.16–3.72]), and hypocalcemia (ORs [95%CI], 1.86 [1.04–3.35]) were independently associated with technique failure. Adding corrected calcium to the model incorporating age, body mass index, and hemoglobin significantly increased the c‐statistic from 0.678 to 0.755 ( P = 0.048) relative to the model incorporating age alone. The integrated discrimination improvement was 0.085 (95% CI 0.036–0.134, P < 0.001) and the continuous net reclassification improvement was 0.395 (95% CI 0.066–0.724, P = 0.02). In conclusion, the combination of predialysis indices comprising age, overweight/obesity, anemia, and corrected calcium could provide a significant predictive value for technique failure of PD.