title: Lower plasma visceral protein concentrations are independently associated with higher mortality in patients on peritoneal dialysis.
abstract: Protein-energy wasting (PEW) is strongly associated with high mortality in continuous ambulatory peritoneal dialysis (CAPD) patients. However, its clinical assessment has not been well defined. The aim of the present study was to investigate the relationship between combined nutritional indicators and mortality in CAPD patients. In the present retrospective cohort study, a total of 885 incident CAPD patients were enrolled. Nutritional status at the initiation of CAPD was assessed by BMI and biochemical indices (serum albumin, prealbumin, transferrin, creatinine and total cholesterol). The primary outcome was all-cause mortality. Principal components factor analysis was used to identify the combined nutritional parameters. Their association with mortality was examined by multivariable-adjusted Cox models. The mean age was 47·4 (SD 14·8) years, 59·2 % (n 524) were male and 24·6 % (n 218) were diabetic. Of the total patients, 130 (14·7 %) had BMI < 18·5 kg/m², 439 (49·6 %) had albumin < 38 g/l ( < 3·8 g/dl), 303 (34·2 %) had prealbumin < 300 mg/l ( < 30 mg/dl), 404 (45·6 %) had transferrin < 2 g/l ( < 200 mg/dl), 501 (56·6 %) had total cholesterol < 5·2 mmol/l ( < 200 mg/dl) and 466 (52·7 %) had creatinine < 707 μmol/l ( < 8 mg/dl). Overall, three components such as visceral proteins, muscle-mass surrogate and BMI were extracted, which explained 69·95 % of the total variance of the nutritional parameters. After adjusting for demographic variables, co-morbid conditions, Hb, TAG and high-sensitivity C-reactive protein, the factor score of visceral proteins including albumin, prealbumin and transferrin was independently associated with mortality (hazard ratio 0·73, 95 % CI 0·60, 0·89; P= 0·002). Lower visceral protein concentrations may be independently associated with higher mortality in incident CAPD patients. Simultaneous measurements of serum albumin, prealbumin and transferrin could be helpful to monitor PEW.
authors.affiliation: Department of Nephrology,The First Affiliated Hospital, Sun Yat-sen University,58th, Zhongshan Road II,Guangzhou510080,People's Republic of China.
authors.forename: Rong
authors.initials: R
authors.lastname: Huang
authors.affiliation: Department of Nephrology,The First Affiliated Hospital, Sun Yat-sen University,58th, Zhongshan Road II,Guangzhou510080,People's Republic of China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Nephrology,The First Affiliated Hospital, Sun Yat-sen University,58th, Zhongshan Road II,Guangzhou510080,People's Republic of China.
authors.forename: Haishan
authors.initials: H
authors.lastname: Wu
authors.affiliation: Department of Nephrology,The First Affiliated Hospital, Sun Yat-sen University,58th, Zhongshan Road II,Guangzhou510080,People's Republic of China.
authors.forename: Qunying
authors.initials: Q
authors.lastname: Guo
authors.affiliation: Department of Nephrology,The First Affiliated Hospital, Sun Yat-sen University,58th, Zhongshan Road II,Guangzhou510080,People's Republic of China.
authors.forename: Chunyan
authors.initials: C
authors.lastname: Yi
authors.affiliation: Department of Nephrology,The First Affiliated Hospital, Sun Yat-sen University,58th, Zhongshan Road II,Guangzhou510080,People's Republic of China.
authors.forename: Jianxiong
authors.initials: J
authors.lastname: Lin
authors.affiliation: Department of Nephrology,The First Affiliated Hospital, Sun Yat-sen University,58th, Zhongshan Road II,Guangzhou510080,People's Republic of China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Zhou
authors.affiliation: Department of Nephrology,The First Affiliated Hospital, Sun Yat-sen University,58th, Zhongshan Road II,Guangzhou510080,People's Republic of China.
authors.forename: Xueqing
authors.initials: X
authors.lastname: Yu
authors.affiliation: Department of Nephrology,The First Affiliated Hospital, Sun Yat-sen University,58th, Zhongshan Road II,Guangzhou510080,People's Republic of China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001798:Blood Proteins / Q000032:analysis*; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D015536:Down-Regulation; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects* / Q000401:mortality; D025341:Principal Component Analysis; D011502:Protein-Energy Malnutrition / Q000097:blood* / Q000209:etiology / Q000401:mortality; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D001798:Blood Proteins
keywords: Mortality