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Number of Daily Peritoneal Dialysis Exchanges and Mortality Risk in a Chinese Population
Xueqing Yu1,2, Jianghua Chen3, Zhaohui Ni4
1Institute of Nephrology, Guangdong Medical University, Guangdong, China.
Insights
Performing four or more daily exchanges in continuous ambulatory peritoneal dialysis (CAPD) significantly reduces mortality risk compared to fewer than four exchanges. This benefit is most pronounced in younger and rural Chinese patients.
Area of Science:
- Nephrology
- Renal Replacement Therapy
- Public Health
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a key treatment for end-stage renal disease.
- Dialysis exchange frequency is a modifiable factor in CAPD patient management.
- Understanding the impact of CAPD exchange volume on outcomes is crucial for optimizing patient care.
Purpose of the Study:
- To investigate the association between daily dialysis exchange frequency and mortality risk in a large Chinese CAPD cohort.
- To compare outcomes for patients performing ≥ 4 exchanges/day versus < 4 exchanges/day.
Main Methods:
- Retrospective analysis of a Chinese CAPD patient database (2005-2015).
- Utilized cause-specific Cox proportional hazards and Fine-Gray competing risks models.
- Matched and adjusted for numerous demographic, clinical, and center-specific variables.
Main Results:
- Analyzed 100,022 patients over 239,876 patient-years.
- Patients performing ≥ 4 exchanges/day showed a 30-35% lower risk of death compared to those performing < 4 exchanges/day.
- The mortality benefit of ≥ 4 exchanges/day was more significant in younger and rural patient subgroups.
Conclusions:
- Higher daily exchange frequency (≥ 4) in CAPD is associated with significantly reduced mortality in the Chinese population.
- Further research is needed to address limitations such as residual confounding factors and detailed clinical data.
- Optimizing CAPD prescription based on exchange frequency may improve patient survival.
Background:
We report outcomes on ≥ 4 compared with < 4 exchanges/day in a Chinese cohort on continuous ambulatory peritoneal dialysis (CAPD).
Methods:
Data were sourced from the Baxter (China) Investment Co. Ltd Patient Support Program database, comprising an inception cohort commencing CAPD between 1 January 2005 and 13 August 2015. We used cause-specific Cox proportional hazards and Fine-Gray competing risks (kidney transplantation, change to hemodialysis) models to estimate mortality risk on ≥ 4 compared with < 4 exchanges/day. We matched or adjusted for age, gender, employment, insurance, primary renal disease, size of CAPD program, year of dialysis inception, and treatment center.
Results:
We modeled 100,022 subjects from 1,177 centers over 239,876 patient-years. Of these subjects, 43,185 received < 4 exchanges/day and 56,837 ≥ 4 exchanges/day. The proportion of patients on < 4 exchanges/day varied widely between centers. Those on < 4 exchanges/day were significantly older, more often female, of unknown employment, and from rural China. In the various models, ≥ 4 exchanges/day was associated with a significantly lower risk of death by 30% - 35% compared with < 4 exchanges/day. This beneficial effect was greatest in younger and rural patients.
Conclusions:
In this Chinese CAPD cohort, ≥ 4 exchanges/day was associated with significantly lower mortality risk than < 4 exchanges/day. Analyses are limited by residual confounding from unavailability of important prognostic covariates (e.g., comorbidity, socioeconomic factors) and data on residual renal function, peritoneal clearance, and transport status with which to judge the clinical appropriateness of CAPD prescription. Nonetheless, our study indicates this area as a high priority for further detailed study.
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