title: Previous comorbidity and lack of patient free choice of technique predict early mortality in peritoneal dialysis.
abstract: OBJECTIVE
  To study the prognostic factors for mortality and hospital admission for patients on peritoneal dialysis (PD).
  
  
  METHODS
  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.
authors.affiliation: Department of Nephrology, Hospital Universitario Fundación Alcorcón, Madrid, Spain. jmportoles@fhalcorcon.es
authors.forename: José
authors.initials: J
authors.lastname: Portolés
authors.forename: Gloria
authors.initials: G
authors.lastname: Del Peso
authors.forename: M José
authors.initials: MJ
authors.lastname: Fernández-Reyes
authors.forename: M Auxiliadora
authors.initials: MA
authors.lastname: Bajo
authors.forename: Paula
authors.initials: P
authors.lastname: López-Sánchez
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D010530:Peritoneal Dialysis; D026684:Personal Autonomy; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate