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Li Y, Xing T, Xu R, Liu Y, Zhong X, Liu Y, Tan R. Single-pool model urea clearance index is associated with sarcopenia and nutritional status in patients undergoing maintenance hemodialysis: a cross-sectional study. BMC Nephrol 2024; 25:80. [PMID: 38443824 PMCID: PMC10916151 DOI: 10.1186/s12882-024-03510-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/18/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The single-pool model urea clearance index (single-pool Kt/Vurea; spKt/V) is the most commonly used method for dialysis adequacy assessment. However, only a few studies have examined the relationship between spKt/V values and parameters related to sarcopenia and nutritional status. This study aimed to evaluate whether the spKt/V is an indicator of sarcopenia and nutritional status in patients undergoing maintenance hemodialysis (MHD). METHODS A total of 142 patients were included in this single-center, cross-sectional study. Venous blood samples were collected shortly before the hemodialysis session. The adequacy of dialysis in patients receiving MHD was assessed using spKt/V. Sarcopenia was identified according to the Asian Working Group for Sarcopenia (2019) definition. Receiver operating characteristic curve and area under the curve were used to evaluate the predictive value of spKt/V in sarcopenia. Univariate and multivariate binary logistic regression analyses were used to determine the association between spKt/V and sarcopenia and nutritional status. RESULTS The mean spKt/V level was 1.3 ± 0.2, the prevalence of sarcopenia was 15.5% in patients on MHD. The best cutoff value of spKt/V in sarcopenia was 1.45 for both sexes, 1.33 and 1.45 for men and women, respectively (P < 0.05). The multivariate binary logistic regression shown that the spKt/V was independently positively associated with sarcopenia (OR = 122.88, 95% CI = 0.64-0.87, P = 0.002). Grouping spKt/V by the best cutoff value, when spKt/V ≥ 1.45, the OR of sarcopenia was 11.75 (95% CI = 3.16-43.67, P < 0.001). Subgroup analyses showed that when spKt/V ≥ 1.33 in men and spKt/V ≥ 1.45 in woman, the OR of sarcopenia was 9.73 (95% CI = 2.25-42.11, P = 0.002) and 14.52 (95% CI = 1.06-199.67, P = 0.045), respectively. CONCLUSIONS The present study showed that spKt/V was an important influencing factor of sarcopenia and malnutrition in Asian patients on MHD.
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Affiliation(s)
- Yan Li
- Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Tingting Xing
- Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Rong Xu
- Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Yan Liu
- Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
- Department of Clinical Nutrition, Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Xiaoshi Zhong
- Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Yun Liu
- Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
- Department of Clinical Nutrition, Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Rongshao Tan
- Department of Clinical Nutrition, Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China.
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2
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Wei S, Jiao J, Yu Y, Tian X, Yang X, Feng S, Li Y, Zhang P, Bai M. Long-term arteriovenous fistula prognosis for maintenance hemodialysis patients who accepted PIRRT by using arteriovenous fistula. Int J Artif Organs 2023; 46:195-201. [PMID: 36945121 DOI: 10.1177/03913988231162384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Maintenance hemodialysis (MHD) patients are often admitted to the hospital for severe morbidities. Prolonged intermittent renal replacement therapy (PIRRT) is required during the hospital staying. There are controversial opinions on the use of arteriovenous fistula (AVF) as vascular access for PIRRT in MHD patients. METHODS Patients with AVF who accepted PIRRT in our center between January 2014 and June 2021 were retrospectively screened. AVF dysfunction and patient mortality were assessed as endpoints. Univariate and multivariate regression models were employed to identify the risk factors of AVF dysfunction. RESULTS About 162 patients were included in our present study. Twenty-six experienced AVF dysfunction, of whom 53.8%, 19.2%, and 27.0% had percutaneous transluminal balloon angioplasty, surgical revision, and AVF reconstruction, respectively. The accumulated AVF dysfunction rates were 11.8%, 16.2%, and 21.0% in 1, 2, and 3 years, respectively. Multivariate analysis revealed that smoking (HR 2.750, 95% CI 1.181-6.402, p = 0.019), higher platelet (PLT, HR 1.009, 95% CI 1.000-1.017, p = 0.047), higher prothrombin activity (PTA, HR 1.039, 95% CI 1.012-1.066, p = 0.004), and lower diastolic blood pressure (DBP, HR 0.963, 95% CI 0.932-0.996, p = 0.026) were independent risk factors for AVF dysfunction. During the follow-up period, 37 patients died. CONCLUSIONS Overall, the use of AVF for PIRRT might not dramatically increase the incidence of AVF dysfunction. And, Smoking, lower DBP, higher PLT, and higher PTA were associated with increased AVF dysfunction.
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Affiliation(s)
- Suijiao Wei
- The Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
- Xi'an Medical University, Xi'an, Shaanxi, China
| | - Jing Jiao
- The Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
- Xi'an Medical University, Xi'an, Shaanxi, China
| | - Yan Yu
- The Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xiujuan Tian
- The Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xiaoxia Yang
- The Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Shidong Feng
- The Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yajuan Li
- The Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Peng Zhang
- The Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Ming Bai
- The Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
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3
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Zou H, Shi Z, Zhang Y, Zhou J, Fang X, Zhang Y, Hu Y, Lou X, Zhou L. Epidemiological characteristics and survival analysis on patients with occupational pneumoconiosis in Zhejiang Province from 1987 to 2019. Front Public Health 2022; 10:1006391. [PMID: 36311604 PMCID: PMC9614357 DOI: 10.3389/fpubh.2022.1006391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/20/2022] [Indexed: 01/27/2023] Open
Abstract
Objective To evaluate risk factors affecting survival in patients diagnosed with pneumoconiosis and propose strategies to improve the quality of life in these patients. Methods The basic patient information was obtained from the pneumoconiosis report card. Disease types, regions, and industry distribution of pneumoconiosis were analyzed. The Kaplan-Meier survival curves and the Cox proportional risk regression model was used for survival analysis. Results A total of 13,812 patients were diagnosed with pneumoconiosis in Zhejiang province from 1987 to 2019. The overall survival rate at the end of life table analysis was 83%. Kaplan-Meier analyses showed that there were significant differences between survival curves depending on the stage of first diagnosis, age at first diagnosis, type of pneumoconiosis, industry, and duration of dust exposure (P < 0.05). The results of Cox proportional hazards regression analysis showed that pneumoconiosis stage of first diagnosis, age at first diagnosis, industry, and duration of dust exposure were risk factors affecting patient survival (P < 0.05). Conclusions The patients with high stage of pneumoconiosis at first diagnosis, older age, and long duration of dust exposure should be followed up and monitored as key population, and the industries with high incidence of pneumoconiosis such as mining and construction should be supervised as key industries.
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Affiliation(s)
- Hua Zou
- Occupational Health and Radiation Protection Institute, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Zhihao Shi
- Jiaxing Center for Disease Control and Prevention, Jiaxing, China
| | - Yixin Zhang
- School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Jiena Zhou
- Department of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xinglin Fang
- Occupational Health and Radiation Protection Institute, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Yijin Zhang
- School of Public Health, Xiamen University, Xiamen, China
| | - Yong Hu
- Occupational Health and Radiation Protection Institute, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Xiaoming Lou
- Occupational Health and Radiation Protection Institute, Zhejiang Center for Disease Control and Prevention, Hangzhou, China,Xiaoming Lou
| | - Lifang Zhou
- Occupational Health and Radiation Protection Institute, Zhejiang Center for Disease Control and Prevention, Hangzhou, China,*Correspondence: Lifang Zhou
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4
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Moorman D, Pilkey NG, Goss CJ, Holden RM, Welihinda H, Kennedy C, Halliday SM, White CA. Twice versus thrice weekly hemodialysis: A systematic review. Hemodial Int 2022; 26:461-479. [PMID: 36097718 DOI: 10.1111/hdi.13045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/27/2022] [Accepted: 08/23/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Thrice weekly hemodialysis (HD) is currently the norm in high income countries but there is mounting interest in twice weekly HD in certain settings. We performed this systematic review to summarize the available evidence comparing twice to thrice weekly HD. METHODS A systematic literature search was performed in Ovid MEDLINE, Ovid Embase, and the Cochrane Central Register of Controlled Trials to identify cohort and randomized controlled trials evaluating outcomes of twice versus thrice weekly HD. The bibliographies of identified studies were hand searched to find any additional studies. Risk of bias was assessed using the Newcastle-Ottawa scale for observational studies. FINDINGS No randomized controlled trials and 21 cohort studies were identified. Overall study quality was modest with high risk of selection bias and inadequate controlling for confounders. The most commonly evaluated outcome measures were survival and residual kidney function. No studies assessed quality of life. Study results were variable and there was no clear signal for overwhelming risk or benefit of twice versus thrice weekly HD with the exception of residual kidney function which consistently showed slower decline in the twice weekly group. DISCUSSION There is a paucity of high quality data comparing the risks and benefits of twice vs thrice weekly HD. Randomized controlled trial evidence is required to inform clinicians and HD prescription guidelines.
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Affiliation(s)
- Danielle Moorman
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Nathan G Pilkey
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Chloe J Goss
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Rachel M Holden
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Hasitha Welihinda
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Claire Kennedy
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Sandra M Halliday
- Queen's University Library, Queen's University, Kingston, Ontario, Canada
| | - Christine A White
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
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5
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Liu SX, Wang ZH, Zhang S, Xiao J, You LL, Zhang Y, Dong C, Wang XN, Wang ZZ, Wang SN, Song JN, Zhao XN, Yan XY, Yu SF, Zhang YN. The association between dose of hemodialysis and patients mortality in a prospective cohort study. Sci Rep 2022; 12:13708. [PMID: 35962178 PMCID: PMC9374660 DOI: 10.1038/s41598-022-17943-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/03/2022] [Indexed: 11/09/2022] Open
Abstract
Dialysis adequacy is a known risk factor for mortality in maintenance hemodialysis (MHD) patients. However, the optimal dialysis dose remains controversial. Therefore, we aimed to explore the relationship between dialysis dose and all-cause and cardiovascular disease (CVD) mortality among MHD. We examined the associations of dialysis dose with mortality in a cohort (n = 558) of MHD patients from 31 December 2015 to 31 December 2020. Dialysis adequacy was assessed using baseline Single-pool Kt/Vurea (spKt/V), which was categorized into three groups, and the lowest dose group was used as the reference category. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression models. A total of 214 patients died (64.5% for CVD). Compared with the low-dose group, high-dose group could reduce the risk of all-cause mortality by 33% (HR = 0.67, 95% CI: 0.47–0.98). Of note, when stratification by age, high-dose group was associated with both lower all-cause (HR = 0.46, 95% CI: 0.26–0.81) and CVD mortality (HR = 0.42, 95% CI: 0.20–0.88) among patients with age below 65 years. When stratification by dialysis age, high-dose group was associated with decreased risk of CVD mortality (HR = 0.43, 95% CI: 0.20–0.91) among patients with dialysis age over 60 months. spKt/V is a simple index of hemodialysis dose used in clinical practice and a useful modifiable factor in predicting the risk of death, especially in MHD patients under 65 years old or dialysis age more than 60 months.
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Affiliation(s)
- Shu-Xin Liu
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China. .,Dalian Key Laboratory of Intelligent Blood Purification, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China.
| | - Zhi-Hong Wang
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China.,Dalian Key Laboratory of Intelligent Blood Purification, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China
| | - Shuang Zhang
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China.,Dalian Key Laboratory of Intelligent Blood Purification, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China
| | - Jia Xiao
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China.,Dalian Key Laboratory of Intelligent Blood Purification, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China
| | - Lian-Lian You
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China.,Dalian Key Laboratory of Intelligent Blood Purification, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China
| | - Yu Zhang
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China.,Dalian Key Laboratory of Intelligent Blood Purification, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China
| | - Cui Dong
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China.,Dalian Key Laboratory of Intelligent Blood Purification, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China
| | - Xue-Na Wang
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China.,Dalian Key Laboratory of Intelligent Blood Purification, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China
| | - Zhen-Zhen Wang
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China.,Dalian Key Laboratory of Intelligent Blood Purification, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China
| | - Sheng-Nan Wang
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China.,Dalian Key Laboratory of Intelligent Blood Purification, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China
| | - Jia-Ni Song
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China.,Dalian Key Laboratory of Intelligent Blood Purification, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China
| | - Xiu-Nan Zhao
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China.,Dalian Key Laboratory of Intelligent Blood Purification, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China
| | - Xin-Yi Yan
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China.,Dalian Key Laboratory of Intelligent Blood Purification, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China
| | - Shu-Fan Yu
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China.,Dalian Key Laboratory of Intelligent Blood Purification, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China
| | - Yi-Nan Zhang
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China.,Dalian Key Laboratory of Intelligent Blood Purification, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, Liaoning, 116033, China
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Jung JY, Yoo KD, Kang E, Kang HG, Kim SH, Kim H, Kim HJ, Park TJ, Suh SH, Jeong JC, Choi JY, Hwang YH, Choi M, Kim YL, Oh KH. Executive summary of the Korean Society of Nephrology 2021 clinical practice guideline for optimal hemodialysis treatment. Korean J Intern Med 2022; 37:701-718. [PMID: 35811360 PMCID: PMC9271711 DOI: 10.3904/kjim.2021.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/12/2022] [Indexed: 12/05/2022] Open
Abstract
The Korean Society of Nephrology (KSN) has published a clinical practice guideline (CPG) document for maintenance hemodialysis (HD). The document, 2021 Clinical Practice Guideline on Optimal HD Treatment, is based on an extensive evidence-oriented review of the benefits of preparation, initiation, and maintenance therapy for HD, with the participation of representative experts from the KSN under the methodologists' support for guideline development. It was intended to help clinicians participating in HD treatment make safer and more effective clinical decisions by providing user-friendly guidelines. We hope that this CPG will be meaningful as a recommendation in practice, but not on a regulatory rule basis, as different approaches and treatments may be used by health care providers depending on the individual patient's condition. This CPG consists of eight sections and 15 key questions. Each begins with statements that are graded by the strength of recommendations and quality of the evidence. Each statement is followed by a summary of the evidence supporting the recommendations. There are also a link to full-text documents and lists of the most important reports so that the readers can read further (most of this is available online).
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Affiliation(s)
- Ji Yong Jung
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon,
Korea
| | - Kyung Don Yoo
- Division of Nephrology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan,
Korea
| | - Eunjeong Kang
- Division of Nephrology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University School of Medicine, Seoul,
Korea
| | - Hee Gyung Kang
- Division of Pediatric Nephrology, Department of Pediatrics, Seoul National University Children’s Hospital, Seoul,
Korea
| | - Su Hyun Kim
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul,
Korea
| | - Hyoungnae Kim
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul,
Korea
| | - Hyo Jin Kim
- Division of Nephrology, Department of Internal Medicine, Pusan National University Hospital, Busan,
Korea
| | | | - Sang Heon Suh
- Division of Nephrology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju,
Korea
| | - Jong Cheol Jeong
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Ji-Young Choi
- Division of Nephrology, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, Daegu,
Korea
| | | | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul,
Korea
| | - Yae Lim Kim
- Department of Biostatistics, Korea University College of Medicine, Seoul,
Korea
| | - Kook-Hwan Oh
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
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7
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Jung JY, Yoo KD, Kang E, Kang HG, Kim SH, Kim H, Kim HJ, Park TJ, Suh SH, Jeong JC, Choi JY, Hwang YH, Choi M, Kim YL, Oh KH. Executive Summary of the Korean Society of Nephrology 2021 Clinical Practice Guideline for Optimal Hemodialysis Treatment. Kidney Res Clin Pract 2021; 40:578-595. [PMID: 34922430 PMCID: PMC8685366 DOI: 10.23876/j.krcp.21.700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 12/17/2022] Open
Abstract
The Korean Society of Nephrology (KSN) has published a clinical practice guideline (CPG) document for maintenance hemodialysis (HD). The document, 2021 Clinical Practice Guideline on Optimal HD Treatment, is based on an extensive evidence-oriented review of the benefits of preparation, initiation, and maintenance therapy for HD, with the participation of representative experts from the KSN under the methodologists’ support for guideline development. It was intended to help clinicians participating in HD treatment make safer and more effective clinical decisions by providing user-friendly guidelines. We hope that this CPG will be meaningful as a recommendation in practice, but not on a regulatory rule basis, as different approaches and treatments may be used by health care providers depending on the individual patient’s condition. This CPG consists of eight sections and 15 key questions. Each begins with statements that are graded by the strength of recommendations and quality of the evidence. Each statement is followed by a summary of the evidence supporting the recommendations. There is also a link to full-text documents and lists of the most important reports so that the readers can read further (most of this is available online).
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Affiliation(s)
- Ji Yong Jung
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Kyung Don Yoo
- Division of Nephrology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Eunjeong Kang
- Division of Nephrology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans College of Medicine, Seoul, Republic of Korea
| | - Hee Gyung Kang
- Division of Pediatric Nephrology, Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Su Hyun Kim
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Hyoungnae Kim
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Hyo Jin Kim
- Division of Nephrology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Tae-Jin Park
- Asan Jin Internal Medicine Clinic, Seoul, Republic of Korea
| | - Sang Heon Suh
- Division of Nephrology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jong Cheol Jeong
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji-Young Choi
- Division of Nephrology, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | | | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Yae Lim Kim
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kook-Hwan Oh
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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8
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Jung JY, Yoo KD, Kang E, Kang HG, Kim SH, Kim H, Kim HJ, Park TJ, Suh SH, Jeong JC, Choi JY, Hwang YH, Choi M, Kim YL, Oh KH. Korean Society of Nephrology 2021 Clinical Practice Guideline for Optimal Hemodialysis Treatment. Kidney Res Clin Pract 2021; 40:S1-S37. [PMID: 34923803 PMCID: PMC8694695 DOI: 10.23876/j.krcp.21.600] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 01/06/2023] Open
Affiliation(s)
- Ji Yong Jung
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Kyung Don Yoo
- Division of Nephrology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Eunjeong Kang
- Division of Nephrology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans College of Medicine, Seoul, Republic of Korea
| | - Hee Gyung Kang
- Division of Pediatric Nephrology, Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Su Hyun Kim
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Hyoungnae Kim
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Hyo Jin Kim
- Division of Nephrology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Tae-Jin Park
- Asan Jin Internal Medicine Clinic, Seoul, Republic of Korea
| | - Sang Heon Suh
- Division of Nephrology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jong Cheol Jeong
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji-Young Choi
- Division of Nephrology, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | | | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Yae Lim Kim
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kook-Hwan Oh
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Wang H, Jin H, Cheng W, Qin X, Luo Y, Liu X, Fu Y, Jiang G, Lu W, Jin C, Pennington M. Cost-effectiveness analysis of hemodialysis plus hemoperfusion versus hemodialysis alone in adult patients with end-stage renal disease in China. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1133. [PMID: 34430574 PMCID: PMC8350641 DOI: 10.21037/atm-21-1100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/23/2021] [Indexed: 11/25/2022]
Abstract
Background This study evaluates the cost-effectiveness of hemodialysis (HD) plus hemoperfusion (HP) with HD alone in adult patients with end-stage renal disease (ESRD) in China. Methods A Markov model was constructed to assess the cost-effectiveness of interventions over a lifetime horizon. Model parameters were informed by the HD/HP trial, the first randomized, open-label multicenter trial comparing survival outcomes and incidence of cardiovascular disease (CVD) for HD + HP versus HD alone, and supplemented by published literature and expert opinion. The primary outcome was the incremental cost-effectiveness ratio (ICER) with respect to quality adjusted life-years (QALY). The robustness of the results was examined in extensive sensitivity analyses. Analyses were conducted from a healthcare perspective. Costs were reported in both Chinese Renminbi (RMB) and US Dollars (USD) in 2019 values. Results The base case ICER of HD + HP is RMB 174,486 (USD 25,251) per QALY, which is lower than the RMB 212,676 (USD 30,778) willingness-to-pay threshold of three times Gross Domestic Product. This conclusion is sensitive to the mortality for patients with no severe CVD events, the incidence of CVD events, and the cost of HP and HD. At a willingness-to-pay threshold of RMB 212,676 (USD 30,778) per QALY gained, the probability that HD + HP is cost-effective is 58%. Conclusions Our results indicate a potential for HD + HP to be cost-effective for patients with ESRD. Further evidence on the longer-term impact of HD + HP on CVD event rates and mortality unrelated to CVD is needed to robustly demonstrate the cost-effectiveness of HD + HP. Trial Registration The HD/HP trial was registered with the Chinese Clinical Trial Registry (ChiCTR-IOR-16009332).
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Affiliation(s)
- Haiyin Wang
- Health Technology Assessment Research Department, Shanghai Health Development Research Centre, Shanghai, China
| | - Huajie Jin
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Wendi Cheng
- Health Technology Assessment Research Department, Shanghai Health Development Research Centre, Shanghai, China
| | - Xiaoxiao Qin
- Health Technology Assessment Research Department, Shanghai Health Development Research Centre, Shanghai, China
| | - Yashuang Luo
- Health Technology Assessment Research Department, Shanghai Health Development Research Centre, Shanghai, China
| | - Xin Liu
- Health Technology Assessment Research Department, Shanghai Health Development Research Centre, Shanghai, China
| | - Yuyan Fu
- Health Technology Assessment Research Department, Shanghai Health Development Research Centre, Shanghai, China
| | - Gengru Jiang
- Renal Division, Department of Internal Medicine, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Lu
- Renal Division, Department of Internal Medicine, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chunlin Jin
- Health Technology Assessment Research Department, Shanghai Health Development Research Centre, Shanghai, China
| | - Mark Pennington
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
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10
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Zhang Z, Cai L, Wu H, Xu X, Fang W, He X, Wang X, Li X. Paricalcitol versus Calcitriol + Cinacalcet for the Treatment of Secondary Hyperparathyroidism in Chronic Kidney Disease in China: A Cost-Effectiveness Analysis. Front Public Health 2021; 9:712027. [PMID: 34368073 PMCID: PMC8333861 DOI: 10.3389/fpubh.2021.712027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/25/2021] [Indexed: 12/31/2022] Open
Abstract
Background: Chronic Kidney Disease (CKD) is a global chronic disease with increasing prevalence in recent years, particularly CKD accompanied by Secondary Hyperparathyroidism (SHPT) leads to reduced quality of life, increased mortality, a considerable economic burden for patients and society. The aim of this study was to investigate the cost-effectiveness analysis of paricalcitol vs. calcitriol + cinacalcet for CKD patients with SHPT in China in 2020. Methods: A Markov model was conducted employing data derived from published literature, clinical trials, official sources, and tertiary public hospital data in China, based on a 10-year horizon from the perspective of the healthcare system. Calcitriol + Cinacalcet was used as the reference group. CKD stage 5 (CKD-5) dialysis patients suffering from SHPT were included in the study. Effectiveness was measured in quality-adjusted life years (QALYs). The discount rate (5%) was applied to costs and effectiveness. Sensitivity analysis was performed to confirm the robustness of the findings. Results: The base case analysis demonstrated that Patients treated with paricalcitol could gain an increase in utility (0.183 QALYs) and require fewer expenditures (6925.612 yuan). One-way sensitivity analysis was performed to showed that impact factors were the price of cinacalcet, the hospitalization costs of patients with paricalcitol and calcitriol, the costs and utilities of hemodialysis and the costs of calcitriol, the costs of paricalcitol regardless of period. Probabilistic simulation analysis displayed when willingness-to-pay was ¥217113, the probability that Paricalcitol was dominant is 96.20%. Conclusion: The results showed that paricalcitol administrated to treat patients diagnosed with Secondary hyperparathyroidism in Chronic Kidney Disease, compared to calcitriol and cinacalcet, might be dominant in China.
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Affiliation(s)
- Zhuolin Zhang
- Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Lele Cai
- Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Hong Wu
- Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China.,Department of Pharmacy, Lianyungang Second People's Hospital, Lianyungang, China
| | - Xinglu Xu
- Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Wenqing Fang
- Department of Health Policy, School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Xuan He
- Department of Health Policy, School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Xiao Wang
- Department of Health Policy, School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Xin Li
- Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China.,Department of Health Policy, School of Health Policy and Management, Nanjing Medical University, Nanjing, China.,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
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11
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Pan S, Zhao DL, Li P, Sun XF, Zhou JH, Song KK, Wang Y, Miao LN, Ni ZH, Lin HL, Liu FY, Li Y, He YN, Wang NS, Wang CL, Zhang AH, Chen MH, Yang XP, Deng YY, Shao FM, Fu SX, Fang JA, Cai GY, Chen XM. Relationships among the Dosage of Erythropoiesis-Stimulating Agents, Erythropoietin Resistance Index, and Mortality in Maintenance Hemodialysis Patients. Blood Purif 2021; 51:171-181. [PMID: 34175850 DOI: 10.1159/000506536] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/13/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Erythropoiesis-stimulating agents (ESAs) constitute an important treatment option for anemia in hemodialysis (HD) patients. We investigated the relationships among the dosage of ESA, erythropoietin resistance index (ERI) scores, and mortality in Chinese MHD patients. METHODS This multicenter observational retrospective study included MHD patients from 16 blood purification centers (n = 824) who underwent HD in 2011-2015 and were followed up until December 31, 2016. We collected demographic variables, HD parameters, laboratory values, and ESA dosages. Patients were grouped into quartiles according to ESA dosage to study the effect of ESA dosage on all-cause mortality. The ERI was calculated as follows: ESA (IU/week)/weight (kg)/hemoglobin levels (g/dL). We also compared outcomes among the patients stratified into quartiles according to ERI scores. We used the Cox proportional hazards model to measure the relationships between the ESA dosage, ERI scores, and all-cause mortality. Using propensity score matching, we compared mortality between groups according to ERI scores, classified as either > or ≤12.80. RESULTS In total, 824 patients were enrolled in the study; 200 (24.3%) all-cause deaths occurred within the observation period. Kaplan-Meier analyses showed that patients administered high dosages of ESAs had significantly worse survival than those administered low dosages of ESAs. A multivariate Cox regression identified that high dosages of ESAs could significantly predict mortality (ESA dosage >10,000.0 IU/week, HR = 1.59, 95% confidence intervals (CIs) (1.04, 2.42), and p = 0.031). Our analysis also indicated a significant increase in the risk of mortality in patients with high ERI scores. Propensity score matching-analyses confirmed that ERI > 12.80 could significantly predict mortality (HR = 1.56, 95% CI [1.11, 2.18], and p = 0.010). CONCLUSIONS Our data suggested that ESA dosages >10,000.0 IU/week in the first 3 months constitute an independent predictor of all-cause mortality among Chinese MHD patients. A higher degree of resistance to ESA was related to a higher risk of all-cause mortality.
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Affiliation(s)
- Sai Pan
- The PLA Medical College, Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - De-Long Zhao
- The PLA Medical College, Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Ping Li
- The PLA Medical College, Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Xue-Feng Sun
- The PLA Medical College, Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Jian-Hui Zhou
- The PLA Medical College, Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Kang-Kang Song
- The PLA Medical College, Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Yong Wang
- The PLA Medical College, Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Li-Ning Miao
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Zhao-Hui Ni
- Department of Nephrology, Renji Hospital, Shanghai Peritoneal Dialysis Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong-Li Lin
- Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Fu-You Liu
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ying Li
- Department of Nephrology, Third Hospital of Hebei Medical University, Kidney Disease Research Center of Hebei Province, Shijiazhuang, China
| | - Ya Ni He
- Department of Nephrology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Nian-Song Wang
- Department of Nephrology, Affiliated The Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Cai-Li Wang
- Department of Nephrology, First Affiliated Hospital of Baotou Medical College, Baotou, China
| | - Ai-Hua Zhang
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Meng-Hua Chen
- Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xiao-Ping Yang
- Department of Nephrology, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, China
| | - Yue-Yi Deng
- Department of Nephrology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Feng-Min Shao
- Department of Nephrology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Shu-Xia Fu
- Department of Nephrology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jing-Ai Fang
- Department of Nephrology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Guang-Yan Cai
- The PLA Medical College, Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Xiang-Mei Chen
- The PLA Medical College, Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
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12
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Mendonca S, Bhardwaj S, Sreenivasan S, Gupta D. Is Twice-weekly Maintenance Hemodialysis Justified? Indian J Nephrol 2021; 31:27-32. [PMID: 33994684 PMCID: PMC8101671 DOI: 10.4103/ijn.ijn_338_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/27/2019] [Accepted: 04/03/2020] [Indexed: 11/06/2022] Open
Abstract
Background: The benefits of twice-weekly dialysis at initiation are significant with respect to access longevity, preservation of residual renal function, economic factors, and patient quality of life. It is widely practiced in developing countries due to resource and financial constraints. We present a 3-year follow-up of patients on twice-weekly dialysis and their outcomes. Material and Methods: This was a 3-year observational follow-up study of patients initiated on twice-weekly hemodialysis. Adequacy and basic cost-effective hematological and biochemical parameters were studied monthly. In case of complications, the patient was shifted to thrice-weekly hemodialysis. Results: 88 incident hemodialysis patients were followed up. Total sessions of hemodialysis (HD) studied were 16,406. The mean hemoglobin level was 9.53 g/dl with hyperphosphatemia in 74.88% patients. The mean residual renal function (RRF) at initiation was 5.71 +/- 3.70 ml/min. The mean interdialytic weight gain was 1.91 +/- 1.26 kg with a mean ultrafiltration of 2600 ± 410 ml. The spKt/V and eKt/V were adequate in 68.54% and 48.34% patients; however, the standard Kt/V of 2 was achieved in only 10.51% patients. Emergency HD was done in 41 sessions (0.24%). There were 24 deaths (27.27%) during this period with the mean time to mortality being 503.12 +/- 296.62 days. Conclusion: Initiation at twice-weekly schedules for patients on maintenance hemodialysis is a viable option with increments in case of requirement, more so in patients with good urine output and residual renal function. The biochemical and hematological parameters were stable and within KDOQI guidelines and do not worsen with time.
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Affiliation(s)
- Satish Mendonca
- Department of Nephrology, Army Hospital (Research and Referral), New Delhi, India
| | - Shweta Bhardwaj
- Department of Nephrology, Base Hospital (Delhi Cantt), Delhi Cantt, New Delhi, India
| | - S Sreenivasan
- Department of Nephrology, Base Hospital (Delhi Cantt), Delhi Cantt, New Delhi, India
| | - Devika Gupta
- Department of Nephrology, Laboratory Sciences and Molecular Medicine, Army Hospital (Research and Referral), New Delhi, India
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13
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Xia X, Qiu Y, Yu J, Lin T, Lu M, Yi C, Lin J, Ye H, Chen W, Mao H, Yang X, Huang F. Ten-year survival of patients treated with peritoneal dialysis: A prospective observational cohort study. Perit Dial Int 2020; 40:573-580. [PMID: 32489134 DOI: 10.1177/0896860820927534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Few studies evaluated over 5-year outcomes of dialysis patients. This study examined 10-year all-cause mortality and death-censored technique failure in a cohort of incident peritoneal dialysis (PD) individuals. METHODS Five hundred and thirty-three incident PD individuals from 2006 to 2008 were prospectively followed up for more than 10 years until 2018. Clinical characteristics at PD initiation were collected. The primary outcome was all-cause mortality, and the secondary outcome was death-censored technique failure. Cox hazards models were fit using clinical characteristics at PD initiation. RESULTS The mean age starting PD for these participants was 48 ± 16 years; 130 (24%) patients had diabetic nephropathy. During follow-up, 208 patients died, and 84 patients experienced technique failures. The 1, 3, 5, and 10 years' survival rates for incident PD patients were 93%, 81%, 64%, and 36%, respectively, and the technical survival rates were 98%, 93%, 85%, and 62%, respectively. Mortality risk was much higher after 3 years on PD. The peritonitis rate was 0.19 episodes per patient-year, and 7 (1.3%) patients had encapsulating peritoneal sclerosis (EPS) giving an incidence rate of 3.1 of 1000 patient-years. The main causes of death were cardiovascular events (97 of 208, 47%), and technique failure was mainly due to peritonitis (41 of 84, 49%). Older age, higher Charlson comorbidity index, and lower level of education were strongly associated with mortality, and diabetic nephropathy was an independent risk factor for technique failure. CONCLUSIONS The 10-year's survival and technique survival rates of incident PD patients were 36% and 62%. Long-term PD can be continued successfully with improved outcomes and low risk for EPS.
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Affiliation(s)
- Xi Xia
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, People's Republic of China
| | - Yagui Qiu
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, People's Republic of China
| | - Jing Yu
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, People's Republic of China
| | - Tong Lin
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, People's Republic of China
| | - Miaoqing Lu
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, People's Republic of China
| | - Chunyan Yi
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, People's Republic of China
| | - Jianxiong Lin
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, People's Republic of China
| | - Hongjian Ye
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, People's Republic of China
| | - Wei Chen
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, People's Republic of China
| | - Haiping Mao
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, People's Republic of China
| | - Xiao Yang
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, People's Republic of China
| | - Fengxian Huang
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, People's Republic of China
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