Impact Of Continuous High Peritoneal Transport Status On The Prognosis Of Peritoneal Dialysis Patients

Objective:To assess the association of initial high peritoneal transport status and continuous high peritoneal transport status within 1 year on the prognosis of peritoneal dialysis(PD)patients.Methods:A retrospective cohort study in a single center was conducted.All patients who started PD from October 1,2010 to May 31,2016 in our hospital peritoneal dialysis center,and had a peritoneal equilibration test(PET)performed within 6 months of PD commencement,were included and followed up until May 31,2017.And criteria also inclusive of those aged ? 18 years at the start of PD and survival for at least 90 days from the first PD therapy.The patients who were catheterized in other hospitals,transferred from permanent HD,or failed renal transplantation were excluded in this study.According to the first 4-hour dialysate to 2-hour plasma ratio of creatinine(D/P Cr),the patients were stratified to high transport group(D/P Cr?0.82)and non-high transport group(D/P Cr<0.82).In addition,according to the review of the D/Pcr value within 1 year in the subgroup analysis of initial high-transport group,it is divided into a continuous high transport group and a non-sustained high transport group.Kaplan-Meier method was used to obtain survival curves and a Cox regression model was used to evaluate risk factors for mortality.Results:503 eligible PD patients were enrolled,the mean age was 49.2±13.9 years and the mean peritoneal dialysis time was 35.0±16.1 months,57.8% were male,19.1%had diabetes,11.1% had CVD events,and 26.0% had peritonitis.There were121(24.1%)patients with high peritoneal transport and 382(75.9%)with non-high peritoneal transport.Kaplan-Meier curve showed that cumulative survival rates at 1-,3-,and 5-year were 89.9%,74.8%,and 26.9% for high transport patients,and 94.4%,81.1%,and 56.2% for non-high transport patients,respectively.High peritonealtransport patients had significantly lower patient survival rate compared to the other group(Log Rank=5.445,P=0.02).Furthermore,there were 45 patients(37.2%)with continuous high transport and 76 patients(62.8%)with non-sustained high transport group in the initial high transport subgroup analysis.The cumulative survival rate of the PD patients in the continuous high transport group was significantly lower than that in the non-sustained high transport group(Log Rank=9.814,P=0.002).Univariate analysis showed that the initial high peritoneal transport(HR=1.745,95%CI: 1.087 to 2.803,P =0.021)was correlated with an increased risk of all-cause mortality,but this association was not significant in multivariable analysis(HR=1.036,95%CI: 0.605 to 1.773,P=0.897).Multivariable analysis showed that continuous high transport group within 1 year(HR=4.195,95%CI=1.605 to 10.964,P=0.003),age(HR=1.048),diabetes(HR=2.021),triglyceride(HR=1.255)and apolipoprotein A1(HR=0.292)was distinctly correlated with an increased risk of all-cause mortality in PD patients.Conclusions:Initial high peritoneal transport status is not an independent risk factor of mortality of PD patients.But the predictors of prognosis in PD patients are continuous peritoneal status within 1 year,age,diabetes,triglyceride,and apolipoprotein A1.