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Plasma fibrinogen and mortality in patients undergoing peritoneal dialysis: a prospective cohort study

ABSTRACT: Background Plasma fibrinogen is significantly associated with cardiovascular (CV) events and mortality in the general population. However, the association between plasma fibrinogen and mortality in patients undergoing peritoneal dialysis (PD) is unclear. Methods This was a prospective cohort study. A total of 1603 incident PD patients from a single center in South China were followed for a median of 46.7?months. A Cox regression analysis was used to evaluate the independent association of plasma fibrinogen with CV and all-cause mortality. Models were adjusted for age, sex, smoking, a history of CV events, diabetes, body mass index, systolic blood pressure, hemoglobin, blood platelet count, serum potassium, serum albumin, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, hypersensitive C-reactive protein, estimated glomerular filtration rate, antiplatelet agents and lipid-lowering drugs. Results The mean age was 47.4?±?15.3?years, 955 (59.6%) patients were male, 319 (19.9%) had a history of CV events, and 410 (25.6%) had diabetes. The average plasma fibrinogen level was 4.12?±?1.38?g/L. Of the 474 (29.6%) patients who died during follow-up, 235 (49.6%) died due to CV events. In multivariable models, the adjusted hazard ratios (HRs) for quartile 1, quartile 3, and quartile 4 versus quartile 2 were 1.18 (95% confidence interval [CI], 0.72–1.95, P?=?0.51), 1.47 (95% CI, 0.93–2.33, P?=?0.10), and 1.78 (95% CI, 1.15–2.77, P?=?0.01) for CV mortality and 1.20 (95% CI, 0.86–1.68, P?=?0.28), 1.29 (95% CI, 0.93–1.78, P?=?0.13), and 1.53 (95% CI, 1.12–2.09, P?=?0.007) for all-cause mortality, respectively. A nonlinear relationship between plasma fibrinogen and CV and all-cause mortality was observed. Conclusions An elevated plasma fibrinogen level was significantly associated with an increased risk of CV and all-cause mortality in patients undergoing PD.

SUBMITTER: Yu J

PROVIDER: S-EPMC7430005 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Project description:BackgroundRecent studies have shown that triglyceride glucose-body mass index (TyG-BMI) is associated with the risk of ischemic stroke and coronary artery disease. However, little attention has been given to the association between TyG-BMI and cardiovascular disease (CVD) mortality in patients undergoing peritoneal dialysis (PD). Therefore, this study aimed to explore the relationship between TyG-BMI and CVD mortality in southern Chinese patients undergoing PD.MethodsIncident patients receiving PD from January 1, 2006, to December 31, 2018, with baseline serum triglyceride, glucose, and body mass index (BMI) information, were recruited for this single-center retrospective cohort study. TyG-BMI was calculated based on fasting plasma glucose, triglyceride, and BMI values. The association between TyG-BMI, CVD and all-cause mortality was evaluated using a multivariate-adjusted Cox proportional hazard regression model.ResultsOf 2,335 patients, the mean age was 46.1 ± 14.8 years; 1,382 (59.2%) were male, and 564 (24.2%) had diabetes. The median TyG-BMI was 183.7 (165.5-209.2). Multivariate linear regression showed that advanced age, male sex, history of CVD, higher levels of albumin and low-density lipoprotein cholesterol, and higher urine output were correlated with a higher TyG-BMI (P < 0.05). During a median follow-up period of 46.6 (22.4-78.0) months, 615 patients died, of whom 297 (48.2%) died as a result of CVD. After adjusting for demographics and comorbidities, TyG-BMI was significantly associated with an increased risk of CVD mortality (hazard ratio [HR] 1.51, 95% confidence interval [CI] 1.05-2.17) and all-cause mortality (HR 1.36, 95% CI 1.05-1.75). After full adjustment, the 28% risk of CVD mortality (HR 1.28, 95% CI 1.13-1.45) and 19% risk of all-cause mortality were elevated (HR 1.19, 95% CI 1.09-1.31) when TyG-BMI increased by 1 stand deviation (SD) (34.2).ConclusionsA higher baseline TyG-BMI was independently associated with an increased risk of CVD and all-cause mortality in patients receiving PD.

Project description:BackgroundCulture-negative peritonitis is a serious complication in patients undergoing maintenance peritoneal dialysis (PD) and occurs in up to 40% of all peritonitis episodes. Despite its high incidence, data regarding treatment response and prognosis remain poorly defined. This study compared the clinical outcomes of patients with culture-negative and positive peritonitis.MethodThis prospective cohort study was conducted between 2021 and 2022. Patients treated with maintenance PD who developed PD-associated peritonitis were included and received standard treatment. The primary endpoint was the primary response (resolution of peritonitis 10 days after the initiation of treatment).ResultsOf the 81 patients who developed PD-associated peritonitis during the study, 35 and 46 had culture-negative and culture-positive peritonitis, respectively. Overall, 52 (64.2%) patients achieved the primary response: 24 (68.6%) in the culture-negative group and 28 (60.9%) in the culture-positive group (p = 0.630). There were no significant differences between the two groups in the incidence of complete cure (complete resolution of peritonitis without the need for Tenckhoff catheter removal or salvage antibiotic therapy or peritonitis within 120 days after treatment) (culture-negative vs. culture-positive group, 57.1% vs. 45.7%), refractory peritonitis (28.6% vs. 41.3%), relapse peritonitis (8.6% vs. 2.2%), repeat peritonitis (11.4% vs. 10.9%), salvage antibiotics (40.0% vs. 50.0%), permanent hemodialysis transfer (11.4% vs. 10.9%), Tenckhoff catheter removal (25.7% vs. 41.3%), or mortality (2.9% vs. 2.2%) (all p > 0.05).ConclusionThis study offers valuable insights into the clinical outcomes of culture-negative peritonitis versus culture-positive peritonitis. However, caution must be exercised in interpreting these findings due to the limitations of the small sample size.Clinical trial registrationThe study was retrospectively registered in the Thai Clinical Trials Registry (TCTR20221130006).

Project description:BackgroundPrevious studies have reported the relationship between thyroid hormone levels and mortality in dialysis patients. However, little is known about the association of free thyroxine (fT4) and mortality in patients on peritoneal dialysis (PD). This study investigated the association between basal and annual variation in fT4 level and mortality in PD patients.MethodsPatients on maintenance PD were enrolled from a prospective multicenter cohort study in Korea; their serum triiodothyronine, fT4, and thyroid-stimulating hormone levels were measured 12 months apart. Patients with overt thyroid disease and those receiving thyroid hormone replacement therapy were excluded from the analysis. Patients were divided into two groups based on the median levels of fT4. The differences of all-cause, infection-related, and cardiovascular mortalities were analyzed between the two groups. The association of basal levels and annual variation with mortality was investigated with Kaplan-Meier curves and Cox proportional hazard models.ResultsAmong 235 PD patients, 31 (13.2%) deaths occurred during the mean follow-up period of 24 months. Infection (38.7%) was the most common cause of death. Lower basal fT4 levels were an independent predictor of all-cause and infection-related death (hazard ratio [HR] = 2.74, 95% confidence interval [CI] 1.27-5.90, P = 0.01, and HR = 6.33, 95% CI 1.16-34.64, P = 0.03, respectively). Longitudinally, patients with persistently lower fT4 levels during the 12-month period had significantly higher all-cause mortality than those with persistently higher levels (HR = 3.30, 95% CI 1.15-9.41, P = 0.03). The area under the receiver operating characteristic curve of fT4 for predicting all-cause and infection-related mortality was 0.60 and 0.68, respectively.ConclusionsfT4 level is an independent predictor of mortality and is especially attributable to infection in PD patients. This predictor was consistent when considering both baseline measurements and annual variation patterns. Close attention to infection in PD patients with relatively lower fT4 levels should be considered.

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Plasma fibrinogen and mortality in patients undergoing peritoneal dialysis: a prospective cohort study

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