Risk factors for death in patients starting PD for their first renal replacement therapy

Peritoneal dialysis (PD) is recommended as the first line of treatment for end-stage renal disease patients in terms of integrated renal replacement therapy (RRT), since PD can preserve residual renal function and fluid homeostasis. However, few analyses have been studied regarding the risk factors for death among patients, including cases transferred from PD. This study retrospectively examined 98 patients (63 years old, male/female ratio : 59/39, non-DM/DM : 57/41) who started PD for their first RRT between Jan. 1999 and Dec. 2003 in a single center. The risk factors for patient death were evaluated During the average observational period of 28 months, 35 cases (35.7 %)were withdrawn from PD, and among these, 24 patients (24.5 %) died (including 7 cases after transferal to HD). The leading causes of death were cardiovascular disease (CVD) and infectious disease in 8, respectively (33.3 % each) and no cases were found who developed encapsulating peritoneal sclerosis. As compared to living patients, the group of patients who died was significantly older and had a high frequency of CVD history. Their serum albumin (Alb) level was significantly lower, whereas the D/P (dialysate/plasma) creatinine (Creat) ratio as well as diastolic blood pressure was higher. In the Cox Hazard model, D/P Creat ratio>0.65(category high/high average), DM nephropathy and history of CVD were independent predictors of death (hazard ratio (HR) : 1.78, 95 %CI : 1.10-2.94, HR : 1.81, 95 %CI : 1.11-3.11, HR : 2.23, 95 %CI : 1.37-3.73). These results suggest that DM nephropathy, history of CVD and higher peritoneal permeability at PD initiation are independent risk factors of death in patients starting PD for their first RRT. Hence, a strict follow-up is needed in these patients.