title: Low prognostic nutritional index associated with cardiovascular disease mortality in incident peritoneal dialysis patients.
abstract: OBJECTIVE
  The prognostic nutritional index (PNI), a variable based on serum albumin concentration and total lymphocyte count in peripheral blood, is reported as a predictor of mortality in a variety of malignant tumor population. This study is aimed to evaluate whether PNI has prognostic value in patients on peritoneal dialysis (PD).
  
  
  METHODS
  This was a single-center, retrospective observational cohort study conducted in incident PD patients from January 1, 2006 to June 30, 2014, and followed until June 30, 2015. The associations of PNI levels with mortality were evaluated by Kaplan-Meier method and Cox proportional hazards models.
  
  
  RESULTS
  A total of 345 patients were included in this study. Median PNI level at baseline was 40.7 (range: 18.8-75.5) for all patients. During follow-up, 59 (17.1%) died during follow-up, among which 31 (52.5%) were due to cardiovascular diseases (CVD). In crude analysis, the patients with low PNI had a significant increase risk of CVD and all-cause mortality [hazard ratio (HR) 3.07, 95% confidence interval (CI) 1.51-6.25 and HR 2.18, 95% CI 1.28-3.72, respectively)]. After adjusting age, Davies comorbidity score, hemoglobin and leukocytes, the patients with low PNI still had a significant increased risk of CVD mortality (HR 2.37, 95% CI 1.10-5.12). However, there was no significant difference in risk of all-cause mortality (HR 1.72, 95% CI 0.97-3.06).
  
  
  CONCLUSIONS
  Low PNI at initiation of PD was independently associated with an increased CVD mortality.
authors.affiliation: Department of Nephrology, Zhujiang Hospital of Southern Medical University, Guangzhou, 510280, China.
authors.forename: Fenfen
authors.initials: F
authors.lastname: Peng
authors.affiliation: Department of Nephrology, Zhujiang Hospital of Southern Medical University, Guangzhou, 510280, China.
authors.forename: Wenjing
authors.initials: W
authors.lastname: Chen
authors.affiliation: Department of Nephrology, Zhujiang Hospital of Southern Medical University, Guangzhou, 510280, China.
authors.forename: Weidong
authors.initials: W
authors.lastname: Zhou
authors.affiliation: Department of Nephrology, Zhujiang Hospital of Southern Medical University, Guangzhou, 510280, China.
authors.forename: Peilin
authors.initials: P
authors.lastname: Li
authors.affiliation: Department of Nephrology, Zhujiang Hospital of Southern Medical University, Guangzhou, 510280, China.
authors.forename: Hongxin
authors.initials: H
authors.lastname: Niu
authors.affiliation: Department of Nephrology, Zhujiang Hospital of Southern Medical University, Guangzhou, 510280, China.
authors.forename: Yihua
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Nephrology, Zhujiang Hospital of Southern Medical University, Guangzhou, 510280, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Nephrology, Zhujiang Hospital of Southern Medical University, Guangzhou, 510280, China. Longhb1966@163.com.
authors.forename: Haibo
authors.initials: H
authors.lastname: Long
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010530:Peritoneal Dialysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Cardiovascular disease; Mortality; Peritoneal dialysis; Prognostic nutritional index