J Prev Med Public Health.  2018 Jul;51(4):205-212. 10.3961/jpmph.18.066.

Regimen-related Mortality Risk in Patients Undergoing Peritoneal Dialysis Using Hypertonic Glucose Solution: A Retrospective Cohort Study

• Sujimongkol C
• Pongskul C
• Promthet S

• KMID: 2418819
• DOI: http://doi.org/10.3961/jpmph.18.066

Abstract

OBJECTIVES
The main purpose of this study was to quantify the risk of mortality linked to various regimens of hypertonic peritoneal dialysis (PD) solution.
METHODS
A retrospective cohort study of patients using home-based PD was carried out. The prescribed regimen of glucose-based PD solution for all patients, determined on the basis of their individual conditions, was extracted from their medical chart records. The primary outcome was death. The treatment regimens were categorized into 3 groups according to the type of PD solution used: original PD (1.5% glucose), shuffle PD (1.5 and 2.5% glucose), and serialized PD (2.5 and 4.5% glucose). Multivariate analysis (using the Weibull model) was applied to comprehensively examine survival probabilities related to the explanatory variable, while adjusting for other potential confounders.
RESULTS
Of 300 consecutive patients, 38% died over a median follow-up time of 30 months (interquartile range: 15-46 months). Multivariate analysis showed that a treatment regimen with continued higher-strength PD solution (serialized PD) resulted in a lower survival rate than when the conventional strength solution was used (adjusted hazard ratio, 2.6; 95% confidence interval, 1.6 to 4.6, p < 0.01). Five interrelated risk factors (age, length of time on PD, hemoglobin levels, albumin levels, and oliguria) were significant predictors contributing to the outcome.
CONCLUSIONS
Frequent exposure to high levels of glucose PD solution significantly contributed to a 2-fold higher rate of death, especially when hypertonic glucose was prescribed continuously.

Keyword

Death; Glucose; Kidney diseases; Peritoneal dialysis; Survival rate; Thailand

MeSH Terms

Cohort Studies*
Follow-Up Studies
Glucose
Glucose Solution, Hypertonic*
Humans
Kidney Diseases
Mortality*
Multivariate Analysis
Peritoneal Dialysis*
Retrospective Studies*
Risk Factors
Survival Rate
Thailand
Glucose
Glucose Solution, Hypertonic