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Department of Nephrology,1 Hospital Universitario Fundación Alcorcón; Department of Nephrology,2 Hospital Universitario La Paz, Madrid; Department of Nephrology,3 Segovia General Hospital, Segovia; Hospital Universitario Fundación Alcorcón,4 Madrid, Spain,b
a This study was conducted by the above authors and C. Sesmero, V. Garrido (Hospital Fundación Alcorcón); A.G. Perez, A. Ramos (Fundación Jimenez Diaz); F. Coronel (Hospital Clínico San Carlos); V. Pérez Díaz (Hospital Clínico Valladolid); J.R. Rodríguez Palomares (Hospital Defensa); J.M. López-Gómez (Hospital Gregorio Marañon); R. Selgas (Hospital Universitario La Paz); M. Prieto (Hospital de Leon); G. Caparros, J. De Santiago (Hospital Nuestra Señora de Alarcos, Ciudad Real); V. Paraíso (Hospital Nuestra Señora de Sonsoles, Avila); A. Cirugeda, T. Andrino (Hospital Princesa); M. Velo, P. de Sequera (Hospital Príncipe de Asturias); A. Molina, C. Ruiz (Hospital Rio Hortega, Valladolid); M. Rivera Gorrin (Hospital Ramón y Cajal); R. Alvarez, F. Yánez (Hospital Segovia); C. Muñoz de la Paz (Hospital Severo Ochoa); F. Ahijado, R. Díaz-Tejeiro (Hospital V. Salud, Toledo); E. López, J. Martín Gago (Hospital Virgen de Carrión, Palencia).
b These centers are included in the public research renal network REDinREN (Instituto Carlos III de Investigación, Red 6/0016) and Instituto Reina Sofía de Investigación Nefrológica.
Correspondence to: J. Portolés, Department of Nephrology, Fundación Hospital Alcorcón, Avda Villaviciosa 1, Alcorcón 28922 Madrid, Spain. jmportoles{at}fhalcorcon.es
Objective: To study the prognostic factors for
mortality and hospital admission for patients on peritoneal dialysis
(PD). Method: Biannual data on individual characteristics,
clinical and analytical progress, treatment, and events were studied for a
cohort of incident patients undergoing PD (2003–2006) in a reference
area of 8.8 million people. Results: 489 patients (age 53.58 years, 61.6% male)
with 3-year follow-up were included. They presented at inclusion with Charlson
Comorbidity Index (CCI) of 5.25; previous cardiovascular (CV) event, 23.7%;
diabetes mellitus (DM), 19.1%; and hypertension (HT), 89.9%. Annual
hospitalization rate per patient-year at risk was 0.6. The variables that
predicted admission were CCI [odds ratio (OR) 1.14 per point], DM (OR 1.66),
and previous CV event (OR 1.90). Anemia maintained significance when corrected
for CCI: hemoglobin, 0.79 per 1 g/dL Hb; CCI, 1.15 per point. Annual mortality
rate was 5.4%. Those that died were older (67.47 vs 52.78 years) and had a
higher CCI (8.35 vs 5.0), a lower initial Hb (11.5 vs 12.2 g/dL), a higher
hospital admission rate, a higher annual rate of peritonitis, more previous CV
events (50.0% vs 22.1%), and higher prevalence of DM (38.5% vs 17.9%).
Survival analysis identified the following prognostic factors: CCI [hazard
ratio (HR) 1.51 per point], CV event (HR 2.85), DM (HR 2.52), age (HR 1.06 per
year), and mandatory referral to PD (HR 6.54). The effect of CV events and DM
persisted after correction for age, and that of choice of technique after
correcting for CCI and/or age. Conclusions: The CCI is useful for risk estimation in
PD patients. Previous CV event, DM, and age are the most relevant risk
factors. Control of anemia has prognostic value for hospital admissions.
Mandatory referral to PD is associated with higher mortality. The prognosis in
PD depends on predialysis patient management.
KEY WORDS: Cardiovascular event; dialysis choice; epidemiology; mortality.
Received 2 April 2008; accepted 4 July 2008.
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