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Value of combining inflammation, malnutrition, and calcification for predicting all-cause and cardiovascular mortality in peritoneal dialysis patients

ZHOU Yan, FANG Wei, YAN Hao, YUAN Jiang-zi, LI Zhen-yuan, YU Zan-zhe, HUANG Jia-ying, NI Zhao-hui, QIAN Jia-qi   

  1. Department of Nephrology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Peritoneal Dialysis Research Center， Shanghai 200127, China
  • Online:2016-09-28 Published:2016-10-31
  • Supported by:

    Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support， 20152211； Project of Shanghai Municipal Science and Technology Commission， 114119a5900

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Abstract:

Objective·To explore whether the combined use of inflammation, malnutrition, and cardiac valve calcification allows better all-cause and cardiovascular mortality risk stratification in peritoneal dialysis (PD) patients. Methods·Patients underwent regular PD in PD center of Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine from March 2011 to August 2013 were enrolled in this study. Cardiac valve calcification (CVC) in patients was detected using two-dimensional echocardiography. The patients were assigned to 4 groups based on 0, 1, 2 and all 3 risk markers, namely high high-sensitive C-reactive protein (hs-CRP), low serum albumin and CVC. All patients were followed up prospectively until death, PD discontinuation, or October 31, 2015. Cox proportional hazard model was used to analyze the prediction of all-cause and cardiovascular mortality by 0, any 1, 2 and all 3 risk markers. Results·A total of 189 PD patients with mean age of (55.8±15.2) years and median dialysis time of 20 months (9-42.5) were enrolled in this study. Among them, 99 (52.4%) were males and 32 (16.9%) had diabetes mellitus. CVC was presented in 60 (31.7%) patients. By the end of study, 46 patients died and 28 deaths were due to cardiovascular events. The patients with 3 and 2 markers had adjusted HR of 4.933 (95%CI 1.674-14.540，P=0.004) and 2.762 (95%CI 1.107-6.892，P=0.029) for all-cause mortality compared with those with 0 risk marker. The adjusted HR for cardiovascular mortality were 7.719 (95%CI 1.916-31.088, P=0.004) and 3.728 (95%CI 1.126-12.344, P=0.031) in patients with 3 and 2 markers. A combination of 3 markers increased the area under the curves of all-cause and cardiovascular mortality compared with any single marker. Conclusion·A combination of inflammation, malnutrition, and CVC can better predict the prognosis of PD patients and allow better all-cause and cardiovascular mortality risk stratification in PD patients.

Key words: inflammation, malnutrition, calcification, mortality, peritoneal dialysis