Predictors of death in patients on peritoneal dialysis: the Missouri Peritoneal Dialysis Study.
BACKGROUND
The study was designed to identify predictors of death in subjects on peritoneal dialysis (PD).


METHODS
The population consisted of patients initiated on PD at the University of Missouri-Columbia and Dialysis Clinic Incorporated from January 1, 1990, through December 31, 1999. Baseline variables included demographics, clinical data, initial measures of nutritional status, adequacy, and transport characteristics. Co-morbidities were scored using a modified version of the Index of Coexistent Disease. Ongoing (during the course of PD) variables consisted of clinical characteristics and weighted time average of a number of laboratory, adequacy, and nutritional variables. The variables were screened using a univariate procedure, and then analyzed using stepwise logistic regression to evaluate their independent relation to death.


RESULTS
There were 105 men and 86 women--180 Caucasians, 10 African-American, 1 Asian, mean age 61 +/- 13 (SD) years, and mean duration of follow-up 21 +/- 18 months. Eighty-two patients suffered the outcome of death. Lean body mass (LBM) at the initiation of PD was negatively associated with the risk of death (p < 0.01). In addition, the need for a partner to perform PD, total morbidity count, and the summated severity score of all co-morbidities were associated with an increased risk of death. The analysis of ongoing variables revealed that serum phosphate (negative association, p = 0.02) and number of hospitalization days per month on PD (p = 0.0006) were associated with an increased risk of death.


CONCLUSIONS
Phosphate levels and LBM are strong negative predictors of death in PD subjects. Further, patients who need the assistance of a partner to perform PD have decreased survival.
Trivedi
Hariprasad
H
Harry S. Truman Memorial Veterans' Hospital, Division of Nephrology, University of Missouri-Columbia, Columbia, MO, USA. htrivedi@mail.mcw.edu
Tan
Seng Hoe
SH
Prowant
Barbara
B
Sherman
Ashley
A
Voinescu
C Gentiana
CG
Atalla
Jamal
J
Khanna
Ramesh
R
Nolph
Karl
K
D000368:Aged; D001823:Body Composition; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000401:mortality*; D010710:Phosphates / Q000097:blood; D011379:Prognosis; D012944:Social Support
D010710:Phosphates