Qingdong Xu

The relationship between metabolic score for insulin resistance index (METS-IR) and all-cause and cardiovascular disease (CVD) mortality in peritoneal dialysis (PD) patients remains unexplored. Hence, we aimed to assess the association of METS-IR with mortality, specifically examining sex differences. In this multicenter cohort study, a total of 3,471 patients were enrolled between 01 January 2006 and 31 December 2017. Associations between METS-IR and all-cause and CVD mortality were examined using multivariate Cox regression analysis, with sex-based differences also assessed. Participants had a mean age of 51.34 ± 14.61 years, 44.04% female. The mean MESTS-IR in Quartile 1, Quartile 2, Quartile 3, and Quartile 4 was 26.22 ± 2.18, 31.40 ± 1.21, 35.94 ± 1.42 and 44.07 ± 5.29 respectively. A comparison of Quartile 4 to Quartile 1 using the multivariate Cox regression analysis revealed significant increases in the hazard ratio (HR) for all-cause mortality (HR: 1.42, 95% confidence interval (CI): 1.02 to 1.97) and CVD mortality (HR: 1.78, 95% CI: 1.16 to 2.54) in the entire population. In female PD patients, the Quartile 4 was associated with an approximately 126% greater risk of all-cause mortality and 165% greater risk of CVD mortality compared with Quartile 1 in the multivariate analysis. However, the result showed no significance in men. The METS-IR could serve as an effective prognostic indicator of mortality in women undergoing PD, indicating that early detection and intervention toward insulin resistance, represented by the METS-IR index, may offer clinical benefits for this identified group.

Anemia represents a common and clinically significant complication among maintenance hemodialysis (MHD) patients. Rubidium (Rb), which shares biochemical properties with potassium and enters cells through Na⁺/K⁺-ATPase, potentially influences erythrocyte function; however, its relationship with anemia in MHD populations has not been explored. This multicenter cross-sectional investigation enrolled 679 MHD patients from three hospitals in China during September to December 2021. Whole blood Rb concentrations were quantified using inductively coupled plasma mass spectrometry (ICP-MS). Anemia was defined as hemoglobin (Hb) below 11.0 g/dL. The association was evaluated through restricted cubic spline (RCS) analysis, multivariable logistic regression, and linear regression models. Anemia prevalence reached 55.23% in the study population. RCS analysis revealed an approximately linear inverse relationship between ln-transformed Rb and anemia risk (P for nonlinearity = 0.069, P overall < 0.001). Following adjustment for demographic factors, comorbidities, dialysis adequacy, nutritional markers, inflammatory indicators, iron metabolism parameters, and erythropoiesis-stimulating agent usage, each 1 mg/L elevation in Rb corresponded to 77% reduced odds of anemia (OR = 0.23, 95%CI: 0.11-0.39). Patients in the highest Rb quartile exhibited 70% lower anemia risk compared to those in the lowest quartile (OR = 0.30, 95%CI: 0.18-0.51; P for trend < 0.001). Each 1 mg/L Rb increment was associated with 1.471 g/dL higher Hb concentration (β = 1.471, 95%CI: 1.110-1.833). These associations persisted across all examined subgroups. Our findings indicate that elevated whole blood Rb levels independently correlate with reduced anemia prevalence and higher Hb concentrations in MHD patients, positioning Rb as a candidate biomarker for anemia risk stratification in this population.

Recombinant human erythropoietin (rhEPO) fused with human immunoglobulin G (IgG) Fc fragment (rhEPO-Fc) is a novel erythropoiesis-stimulating agent designed to extend plasma half-life and enhance biological activity. However, data on the efficacy and safety of rhEPO-Fc in hemodialysis patients with chronic kidney disease (CKD)-related anemia remain limited. This phase 3 trial enrolled patients from 45 Chinese hospitals. Participants were randomized (2:1) to receive either rhEPO-Fc or rhEPO (Chinese hamster ovary cell-derived) for 28 weeks. The rhEPO-Fc responders were eligible for a 24-week extension period. The primary endpoint was the least square mean (LSM) change in hemoglobin (Hb) levels from baseline between weeks 21 and 28. Among 356 rhEPO-Fc and 178 rhEPO recipients, patients receiving rhEPO-Fc demonstrated non-inferiority Hb maintenance compared with rhEPO. The inter-group LSM differences in the full analysis set and per-protocol set were 3.96 g/L (95% CI: 3.02-4.89; p < 0.001) and 2.27 g/L (95% CI: 0.60-3.95; p = 0.008), respectively. Adverse drug reaction rates were comparable (rhEPO-Fc: 39.2% vs. rhEPO: 40.2%). Dose adjustments due to treatment-emergent adverse events were significantly lower with rhEPO-Fc (0.0% vs. 2.2%; p < 0.05). Deaths unrelated to the study drugs occurred in two rhEPO-Fc and four rhEPO patients. These findings indicated that rhEPO-Fc effectively maintained Hb levels in patients with CKD anemia undergoing hemodialysis, showing comparable efficacy to rhEPO with reduced dosing frequency and a similar safety profile.

A combination of multiple nutritional indexes may more comprehensively and favorably reflect dialysis patient's prognosis. In the present study, we aimed to evaluated the association between total cholesterol/(body mass index × serum albumin) (TC/BA) and mortality in patients with continuous ambulatory peritoneal dialysis (CAPD). We conducted a multicenter retrospective cohort study that included 2907 incident Chinese CAPD patients from seven peritoneal dialysis centers in China between January 1, 2005, and May 31, 2023. The primary outcome was all-cause mortality. We used restricted-cubic-spline plots to explore the shape of the association between TC/BA and outcome. Cause-specific hazard models examined the association between TC/BA and mortality. Of 2907 patients, 754 (25.9%) patients died, including 351 (46.6%) deaths due to cardiovascular disease. A positive linear relationship was observed between TC/BA and all-cause mortality (nonlinear, p = 0.374). In the multivariate cause-specific hazard model, a per-1.0 increase of TC/BA had a 1.29-fold (95% confidence interval [CI] 1.19-1.39) risk of all-cause mortality in the total population. Similar trends were observed in subgroup analyses (all P for interactions > 0.05). Notably, the hazard ratio (HR) of TC/BA (per-1.0 increase) was 1.32 (95% CI 1.23-1.41), 1.29 (95% CI 1.19-1.41), and 1.25 (95% CI 1.22-1.27) times higher than the HR of body mass index (per-1.0 decrease), total cholesterol (per-10 increase), and serum albumin (per-1.0 decrease), respectively. TC/BA was positively linearly related to mortality and may outperform each index in assessing CAPD patient prognosis. The combined nutritional index may more comprehensively and favorably evaluate CAPD patients' prognosis.

End-stage renal disease (ESRD) is often complicated by left ventricular dysfunction, which is associated with a poor prognosis. This study aims to investigate the association between baseline left ventricular ejection fraction (LVEF) plus left ventricular end-diastolic diameter (LVEDD) with outcomes in peritoneal dialysis (PD) patients. In this multicenter retrospective study, 1,511 incident Chinese patients on PD between 1 January 2005 and 31 December 2021 were enrolled. Restricted cubic splines (RCS) were used to explore the non-linear associations between LVEF+LVEDD and the risk of mortality. Parametric models for interval-censored survival-time data (stintreg) were used to examine the association between LVEF+LVEDD quartiles and the outcomes. During 6,451.11 person-years of follow-up [median 4.81 (IQR 3.61-6.81) years], 247 (17.8%) patients died, including 88 cardiovascular deaths. RCS showed a U-shaped association between LVEF+LVEDD and the risks of all-cause and CV mortality. According to the quartiles, the optimal range of LVEF+LVEDD associated with the lowest risk of all-cause and CV mortality was 103-107, which was set as the reference range. Both higher (≥115) and lower (<103) levels of LVEF+LVEDD were associated with increased risks of all-cause mortality (hazard ratio [HR] 2.20, 95% confidence interval [CI] 1.58-3.07; HR 1.68, 95% CI 1.19-2.36) and cardiovascular mortality (HR 2.51, 95% CI 1.33-4.75; HR 1.86, 95% CI 0.96-3.61). Low and high levels of baseline LVEF+LVEDD were associated with increased risks of all-cause and cardiovascular mortality in PD patients.

Purpose: Systemic inflammation biomarkers, derived from routine blood tests, have been demonstrated to be associated with prognosis of patients undergoing peritoneal dialysis (PD). However, studies focusing on the comparisons of their role on predictive efficacy for prognosis of PD patient are limited and results are inconsistent. The purpose of this study was to evaluate the prognostic value of various systemic inflammation biomarkers and to identify the optimal one in PD patients. Patients and Methods: This longitudinal study involved 3,225 patients undergoing PD across China. The prognostic accuracy of systemic inflammatory biomarkers was evaluated using C-statistics. Independent prognostic biomarkers of outcomes were determined using multivariate Cox proportional hazards regression analysis. Results: During a 46-month follow-up, 829 (25.7%) patients died, with 458 (55.3%) deaths attributed to cardiovascular disease (CVD). The highest C-statistics were observed for the IBI, with 0.619 and 0.621 for all-cause and CVD mortality, respectively. The optimal threshold of the IBI for predicting prognosis in patients undergoing PD was 50.0. An elevated IBI was a significant independent predictor of all-cause mortality, with a 1-SD increase associated with higher risks of all-cause and CVD mortality. Participants in the upper two quartiles of IBI exhibited increased risks of all-cause mortality by 41.2% and 67.6%, respectively, compared to those in the lowest quartile. Similar results were observed for CVD mortality. Conclusion: The IBI is a superior prognostic indicator of survival and could be broadly applied for prognosis of patients undergoing PD. Elevated IBI is an independent risk factor for all-cause and CVD mortality.

Although peritoneal dialysis (PD) is an efficient therapy for renal replacement, the long-term survival rate of patients undergoing PD remains low. The platelet-to-albumin ratio (PAR), recently identified as a parameter of inflammatory and nutritional status, is associated with an adverse prognosis for various diseases. However, the association between the serum PAR and prognosis of patients undergoing PD is poorly understood. This study aimed to evaluate whether the PAR is a reliable predictor of cardiovascular disease (CVD) and all-cause mortality in patients undergoing PD. This multicenter cohort study enrolled patients undergoing PD from January 1, 2009, to September 30, 2018. The patients were divided into four groups according to the quartiles of their baseline PAR. The primary endpoint was all-cause and CVD-related mortality. Cox proportional hazard models were used to determine the association between the PAR and all-cause or CVD-related mortality. The receiver operating characteristic (ROC) curve was utilized to compare the performance among PAR and other inflammatory indicators. C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were applied to examine the incremental prognostic value of PAR compared with baseline model for predicting all-cause and CVD mortality. A total of 2825 patients were included. During the follow-up period of 47.5 ± 28.3 months, 747 (26.4%) mortality cases were observed, of which 415 (55.6%) were CVD-related. Compared with the Q1 (PAR < 4.43), placement in Q4 (PAR > 7.27) was associated with an increased risk of all-cause mortality and CVD mortality (p < 0.001). The adjusted restricted cubic spline analysis indicated that the relationship of the PAR with all-cause and cardiovascular mortality was linear (p for nonlinearity = 0.289 and 0.422, respectively). No positive correlations were shown in the interaction tests. PAR exhibited superior predictive value for mortality compared to other inflammatory indicators, with a respective AUC value of 0.611 (P < 0.001) for all-cause mortality and 0.609 (P < 0.001) for cardiovascular mortality. According to the C-statistic, continuous NRI and IDI, the addition of PAR to the baseline model yielded a moderate but significant improvement in outcome prediction. The PAR is an independent prognostic factor associated with all-cause and cardiovascular mortality in patients undergoing PD.

Gastrointestinal bleeding is an important gastrointestinal complication among peritoneal dialysis patients and correlated with a higher risk of mortality. Increased uric acid levels are a significant complication for peritoneal dialysis patients and have been associated with an increased risk of hemorrhagic stroke. The objective of the present study was to investigate the relationship between serum uric acid levels and gastrointestinal bleeding in peritoneal dialysis patients. A total of 2498 peritoneal dialysis patients were recruited. Based on the optimal uric acid cutoff value, two groups of patients were divided. We constructed a propensity-score-matched population of 1762 patients by matching sex, age, and body mass index. Survival outcomes between the two groups were compared using adjusted Kaplan-Meier curves. We constructed the restricted cubic splines regression to assess the correlation between levels of uric acid and gastrointestinal bleeding. A multivariate Cox proportional hazards regression was performed to test whether higher levels of uric acid are an independent risk factor for gastrointestinal bleeding. We performed a forest plot to show interaction effects in different subgroups. According to restricted cubic splines regression, uric acid levels were positively correlated with the risk of gastrointestinal bleeding events. After adjusted different confounding factors, patients with high levels of uric acid were prone to experience gastrointestinal bleeding (HR 1.868, 95%CI 1.001-3.486). In subgroups, the interaction between higher levels of uric acid and utilizing proton pump inhibitors was significant (P for interaction = 0.034). Further research found that taking proton pump inhibitors could decrease the risk of gastrointestinal bleeding in peritoneal dialysis patients accompanied high levels of uric acid. The baseline high levels of uric acid are an independent risk factor for gastrointestinal bleeding in patients undergoing peritoneal dialysis.

Malnutrition and inflammation are associated with mortality in peritoneal dialysis (PD) patients. Serum albumin and non-high-density lipoprotein cholesterol (non-HDL-C) are independently associated with mortality in PD patients. Combining albumin and non-HDL-C with mortality may be more plausible in clinical practice. This retrospective cohort study included 1954 Chinese PD patients from 1 January 2009 to 31 December 2016. Kaplan-Meier curve was used to determine the relationship between albumin to non-HDL-C ratio and all-cause mortality. Cox regression analysis was applied to assess the independent predictive value while adjusting for confounding factors. Competitive risk analysis was used to examine the effects of other outcomes on all-cause mortality prognosis. In the 33-month follow-up period, there were 538 all-cause deaths. Kaplan-Meier analysis presented significant differences in all-cause mortality. Multivariate Cox regression showed that the risk of all-cause mortality was lower in the moderate group (9.36-12.79) (HR, 0.731; 95% CI, 0.593-0.902, p = 0.004) and the highest group (>12.79) (HR, 0.705; 95% CI, 0.565-0.879, p = 0.002) compared to the lowest group (≤9.36). Competitive risk analysis revealed significant differences for all-cause mortality (p < 0.001), while there was no statistical significance for other competing events. Low albumin to non-HDL-C ratio was associated with a high risk of all-cause mortality in PD patients. It may serve as a potential prognostic biomarker in PD patients.

Background: Chronic inflammatory disorders in peritoneal dialysis (PD) contribute to the adverse clinical outcome. Systemic immune inflammation index (SII) is the novel and convenient measurement that is positively associated with various diseases. However, scarce is known regarding the association between SII with all-cause mortality among PD patients. Methods: In this multi-center retrospective cohort study, 1,677 incident patients with PD were enrolled. Eligible patients were stratified into groups based on SII level: tertile 1(< 456.76), tertile 2(456.76 to 819.03), and tertile 3(> 819.03). The primary endpoint was the all-cause mortality. Both Cox regression analysis and competing risk models were used to examine the association between SII and all-cause mortality. Subgroup analysis was performed to assess the influence of the SII tertiles on all-cause mortality in different subgroups. Results: During the follow-up period of 30.5 ± 20.0 months, 26.0% (437/1,677) patients died, of whom the SII tertile 3 group accounted for 39.1% (171/437) of the deaths. Patients in the SII tertile 3 group had a higher all-cause mortality rate than patients in the SII tertile 1 and 2 groups (log-rank = 13.037, P < 0.001). The SII tertile 3 group was significantly associated with 80% greater risk (95% confidence interval:1.13 to 2.85; P = 0.013) compared with the SII tertile 1 group in multivariable Cox regression analysis. The competing risk model also indicated that the relationship between SII tertiles and all-cause mortality remains (subdistribution hazard ratio: 1.86; 95% confidence interval: 1.15 to 2.02, P = 0.011). Furthermore, the relationship between the log-transformed SII and all-cause mortality in patients with PD was nearly linear (P = 0.124). Conclusion: A close relationship was observed between the SII and all-cause mortality in patients undergoing PD, suggesting that more attention should be paid to the SII, which is a convenient and effective measurement in clinical practice.