Factors that Might Adversely Affect Short-Term Survival of Patients Starting Peritoneal Dialysis and use of those Factors to Predict Outcome—A Single-Center Experience

Abstract

Objective

Patients initiated on peritoneal dialysis (PD) have significant morbidity and mortality. It would be important to know which factors have an adverse impact on outcome in the first 6 months of PD and whether those factors could be used to predict patient outcome.

Methods

We identified 64 PD patients from a prospectively collected database of all consecutive patients with end-stage renal failure (ESRF) seen at our tertiary referral center between January 2000 and June 2001. The patients were divided into two groups according to whether they were still living or had died by 6 months after the start of PD. Two patients defaulted on follow-up. In the remaining 62 patients, we compared multiple parameters and identified factors that we then evaluated as prediction tools.

Results

Significant differences were noted between the groups (died vs still living) with respect to race (non Chinese: 35.3% vs 13.3%), ischemic heart disease (IHD: 70.6% vs 62.2%), two-dimensional echo ejection fraction (EF: 42% ± 19% vs 53% ± 17%), regional wall motion abnormality (RWMA: 53% vs 22%), serum albumin 28 ± 1 g/L vs 31±5 g/L), alkaline phosphatase (ALP: 140 ± 118 U/L vs 101 ± 36 U/L). No differences were observed with respect to age, sex, cause of ESRF, diabetes status, hypertension, hyperlipidemia, stroke, hemoglobin, or intact parathyroid hormone. As expected, patients in the group that had died by 6 months spent a higher total number of days in hospital (66 ± 47 days vs 43 ± 29 days) and had more cardiovascular events (58.8% vs 6.6%); however, no difference was observed with respect to septic events. The utility of IHD, albumin, ALP, EF, and RWMA as predictors of short-term mortality either singly or in combination were analyzed. We found that those factors were neither sensitive nor specific at predicting mortality in this group of patients.

Conclusions

Race (non Chinese), prior IHD, two-dimensional echo abnormalities (EF and RWMA), low serum albumin, and high serum ALP are factors that affect short-term survival in PD patients. However, it is not possible to predict patient outcome using those factors.