Xueqing Yu1,2, Jianghua Chen3, Zhaohui Ni4, Nan Chen5, Menghua Chen6, Jie Dong7,8, Limeng Chen9, Yusheng Yu10, Xiao Yang2, Wei Fang4, Qiang Yao11, James A Sloand12, Mark R Marshall13,14. 1. Institute of Nephrology, Guangdong Medical University, Guangdong, China. 2. Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. 3. Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China. 4. Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Center for Peritoneal Dialysis Research, Shanghai, China. 5. Department of Nephrology, Ruijin Hospital, the Medical School affiliated to Shanghai Jiaotong University, Shanghai, China. 6. Department of Nephrology, General Hospital of Ningxia Medical University, Ningxia, China. 7. Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing, PR China. 8. Key Laboratory of Renal Disease, National Health and Family Planning Commission of the People's Republic of China, Beijing, PR China. 9. Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. 10. Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China. 11. Baxter China Ltd, Shanghai, People's Republic of China. 12. Baxter Healthcare International, Deerfield, IL, USA. 13. Baxter Healthcare (Asia) Pte Ltd, Singapore mark_roger_marshall@baxter.com markrogermarshall@icloud.com. 14. Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Abstract
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.
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.
Authors: Melissa S Cheetham; Yeoungjee Cho; Rathika Krishnasamy; Arsh K Jain; Neil Boudville; David W Johnson; Louis L Huang Journal: Kidney Int Rep Date: 2021-12-01