title: Early utilization of hypertonic peritoneal dialysate and subsequent risks of non-traumatic amputation among peritoneal dialysis patients: a nationwide retrospective longitudinal study.
abstract: BACKGROUND
  The hemodialysis (HD) population has a particularly high incidence of amputation, which is likely associated with decreased tissue oxygenation during HD. However, information about the risk factors leading to amputation in peritoneal dialysis (PD) patients is limited. Here, we have investigated the association between the use of hypertonic peritoneal dialysate (HPD) and subsequent amputation in PD patients.
  
  
  METHODS
  Based on the data from the Taiwan National Health Insurance research database, this observational cohort study enrolled 203 PD patients who had received HPD early during treatment and had not undergone amputation and 296 PD controls who had not undergone amputation. Subjects were followed through until the end of 2009 and the event rates of new non-traumatic amputation were compared between groups.
  
  
  RESULTS
  The incidence of amputation was 3 times higher for the HPD cohort than for the comparison cohort (23.68 vs. 8.01 per 1000 person-years). The hazard ratio (HR) for this group, estimated using a multivariable Cox model, was 2.48 (95% confidence interval [CI] = 1.06-5.79). The HR for patients with both diabetes and early adoption of HPD increased to 44.34 (95% CI = 5.51-357.03), compared to non-HPD non-diabetic PD controls.
  
  
  CONCLUSIONS
  Early utilization of HPD in PD patients is associated with increasing risk of amputation; this risk considerably increases for those with concomitant diabetes.
authors.affiliation: Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Shih-Yi
authors.initials: SY
authors.lastname: Lin
authors.forename: Che-Chen
authors.initials: CC
authors.lastname: Lin
authors.forename: Chung-Chih
authors.initials: CC
authors.lastname: Lin
authors.forename: Chi-Jung
authors.initials: CJ
authors.lastname: Chung
authors.forename: Horng-Che
authors.initials: HC
authors.lastname: Yeh
authors.forename: I-Kuan
authors.initials: IK
authors.lastname: Wang
authors.forename: I-Wen
authors.initials: IW
authors.lastname: Ting
authors.forename: Chiu-Chin
authors.initials: CC
authors.lastname: Huang
authors.forename: Fung-Chang
authors.initials: FC
authors.lastname: Sung
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000639:trends*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006982:Hypertonic Solutions / Q000008:administration & dosage / Q000009:adverse effects*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000639:trends*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006982:Hypertonic Solutions