title: Peritoneal albumin excretion is a strong predictor of cardiovascular events in peritoneal dialysis patients: a prospective cohort study.
abstract: BACKGROUND
  Microalbuminuria is a marker of systemic endothelial dysfunction. We hypothesize that peritoneal albumin excretion in peritoneal dialysis (PD) patients, which is conceptually analogous to microalbuminuria in non-uremic patients, can predict cardiovascular disease in new PD patients.
  
  
  METHODS
  We studied peritoneal albumin excretion in 43 new PD patients. They were then followed prospectively for the development of cardiovascular events. All-cause mortality and duration of hospitalization for cardiovascular diseases were also recorded.
  
  
  RESULTS
  The average duration of follow-up was 26.5 +/- 17.6 months. During the follow-up period, 15 patients developed cardiovascular events. Event-free survival at 36 months was 81.4% and 53.6% for low (< 300 mg/L) and high (> 300 mg/L) peritoneal albumin excretion groups respectively (log rank test, p = 0.042). By Cox regression analysis, the only independent factors for event-free survival were diabetic status and peritoneal albumin excretion rate. For every 100 mg/L increase in peritoneal albumin excretion, the adjusted hazard ratio of developing a cardiovascular event was 1.83 [95% confidence interval (CI) 1.11 - 3.02, p = 0.018]. Actuarial patient survival at 36 months was 85.7% and 59.1% for low and high peritoneal albumin excretion groups respectively (log rank test, p = 0.10). After adjusting for the duration of follow-up for individual patients, the average duration of hospitalization was 9.1 +/- 16.2 and 21.7 +/- 25.7 days per year of follow-up for low and high peritoneal albumin excretion groups respectively (Mann-Whitney U test, p = 0.012).
  
  
  CONCLUSIONS
  Although the sample size of our present study is small and does not have adequate statistical power, we conclude that peritoneal albumin excretion may be an important predictor of cardiovascular disease. Further studies are needed to examine the role of dialysate albumin excretion as a means of cardiovascular risk stratification in PD patients.
authors.affiliation: Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China. ccszeto@cuhk.edu.hk
authors.forename: Cheuk-Chun
authors.initials: CC
authors.lastname: Szeto
authors.forename: Kai-Ming
authors.initials: KM
authors.lastname: Chow
authors.forename: Christopher Wai-Kei
authors.initials: CW
authors.lastname: Lam
authors.forename: Robert
authors.initials: R
authors.lastname: Cheung
authors.forename: Bonnie Ching-Ha
authors.initials: BC
authors.lastname: Kwan
authors.forename: Kwok-Yi
authors.initials: KY
authors.lastname: Chung
authors.forename: Chi-Bon
authors.initials: CB
authors.lastname: Leung
authors.forename: Philip Kam-Tao
authors.initials: PK
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000418:Albumins / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000209:etiology*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000378:metabolism* / Q000628:therapy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D010537:Peritoneum / Q000378:metabolism*; D011446:Prospective Studies
chemical_list: D000418:Albumins