Risk factors and outcomes of cardiovascular disease readmission within the first year after dialysis in peritoneal dialysis patients

Ren Fail. 2021 Dec;43(1):159-167. doi: 10.1080/0886022X.2020.1866009.

Abstract

Background: In the first year of dialysis, patients are vulnerable to cardiovascular disease (CVD) hospitalization, but knowledge regarding the risk factors and long-term outcomes of cardiovascular readmission within the first year after dialysis in incident continuous ambulatory peritoneal dialysis (CAPD) patients is limited.

Methods: This retrospective cohort study was conducted in incident CAPD patients. The demographic characteristics, laboratory parameters, and CVD readmission were collected and analyzed. The primary outcome was all-cause mortality, and the secondary outcomes included CVD mortality, infection-related mortality and technique failure. A logistic regression was used to identify the risk factors associated with CVD readmission within the first year after dialysis. Cox proportional hazards models were used to evaluate the association between CVD readmission and the outcomes.

Results: In total, 1589 peritoneal dialysis (PD) patients were included in this study, of whom 120 (7.6%) patients had at least one episode of CVD readmission within the first year after dialysis initiation. Advanced age, CVD history, and a lower level of serum albumin were independently associated with CVD readmission. CVD readmission within the first year after dialysis was significantly associated with all-cause (HR 2.66, 95%CI 1.91-3.70, p < 0.001) and CVD (HR 3.42, 95%CI 2.20-5.31, p < 0.001) mortality, but not infection-related mortality or technique failure, after adjusting for confounders.

Conclusions: Our findings suggest that an advanced age, a history of CVD, and a lower level of serum albumin were independently associated with CVD readmission. Moreover, CVD readmission was associated with all-cause and cardiovascular mortality in incident CAPD patients.

Keywords: Cardiovascular disease readmission; outcomes; peritoneal dialysis; risk factors.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / mortality*
  • Cause of Death
  • China / epidemiology
  • Female
  • Humans
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Patient Readmission / statistics & numerical data*
  • Peritoneal Dialysis, Continuous Ambulatory / adverse effects*
  • Peritoneal Dialysis, Continuous Ambulatory / mortality*
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Survival Analysis
  • Time Factors

Grants and funding

This work was partially supported by Group Medical Assistance Project of the Tibet Autonomous Region Natural Science Foundation [Grant no. XZ2019ZR-ZY58(Z)]; the Natural Science Foundation of Guangdong Province, China [Grant no. 2017A030310199, 2018A030310274]; the National Key Research and Development Program of China [Grant no. 2016YFC0906100, 2016YFC0906101]; the Operational Grant of Guangdong Provincial Key Laboratory [Grant no. 2017B030314019]; the Key Laboratory of National Health Commission and Key Laboratory of Nephrology, Guangdong Province, Guangzhou, China [Grant no. 2002B60118]; the Guangdong Provincial Program of Science and Technology [Grant no. 2017A050503003, 2017B020227006]; the Guangzhou Municipal Program of Science and Technology [Grant no. 201704020167]; the Natural Science Foundation of China [Grant No. 81600545, 81570750, 81870575 and 81800632]; 5010 Clinical Program of Sun Yat-sen University [2017007]; and the China Postdoctoral Science Foundation [2019M663314].