A Risk Analysis of Continuous Ambulatory Peritoneal Dialysis-Related Peritonitis

2005 ◽  
Vol 25 (4) ◽  
pp. 374-379 ◽  
Author(s):  
Kai Ming Chow ◽  
Cheuk Chun Szeto ◽  
Chi Bon Leung ◽  
Bonnie Ching-Ha Kwan ◽  
Man Ching Law ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Confidence Interval ◽  
Serum Albumin ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Hazard Ratio ◽  
Albumin Concentration ◽  
Serum Albumin Concentration ◽  
Increased Risk

Objective We studied the clinical characteristics that influence the risk of dialysis-related peritonitis complication in incident Chinese patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods A single center, retrospective, observational cohort study was carried out to examine the risk factors of developing a first episode of dialysis-related peritonitis. Results Between 1995 and 2004, 246 incident CAPD patients were recruited for analysis. During the study period of 897.1 patient-years, 85 initial episodes of peritonitis were recorded. The median peritonitis-free time for diabetic subjects was significantly worse than for nondiabetic subjects (49.0 ± 10.5 vs 82.3 ± 12.6 months, p = 0.0019). The difference was due mainly to a higher likelihood of developing peritonitis with gram-negative organisms in patients with diabetes mellitus ( p = 0.038). Low serum albumin concentration was also associated with worse peritonitis-free survival. There was a nonsignificant trend toward an increased risk for peritonitis in the group of patients with cerebrovascular disease. According to multivariate Cox proportional hazards model for the analysis of time to first peritonitis episode, the two independent risk factors were presence of diabetes mellitus and initial serum albumin concentration. In particular, diabetes mellitus was associated with a hazard ratio of 1.50 and a 95% confidence interval of 1.05 – 2.40 ( p = 0.030) to develop an initial peritonitis. Lower serum albumin level at the start of CAPD was a significant predictor of peritonitis, with hazard ratio of 1.67 for every decrease of 10 g/L, and 95% confidence interval 1.08 – 2.60 ( p = 0.021). Conclusions Our results confirm the susceptibility of diabetic CAPD and hypoalbuminemic patients to peritonitis, and highlight the role of further studies in reducing this complication.

Predicted and Measured Daily Creatinine Production in CAPD: Identifying Noncompliance

1995 ◽  
Vol 15 (1) ◽  
pp. 22-25 ◽  
Author(s):  
Karl D. Nolph ◽  
Zbylut J. Twardowski ◽  
Ramesh Khanna ◽  
Harold L. Moore ◽  
Barbara F. Prowant
Keyword(s):  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Lean Body Mass ◽  
Body Mass ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Albumin Concentration ◽  
Serum Albumin Concentration ◽  
Cross Sectional ◽  
Male Patients ◽  
Sectional Analysis

Objective To evaluate the ratio of measured creatinine (Cr) production to predicted creatinine production as an index of noncompliance in patients on continuous ambulatory peritoneal dialysis (CAPD). Design A cross-sectional analysis. Patients One hundred and twenty-one patients on CAPD. Measurements We have calculated Cr production from measured Cr outputs in 24-hour collections of urine and dialysate. Predicted Cr productions were calculated from standard tables. Weekly KTN urea and weekly Cr clearances were determined from the same 24-hour urine and dialysate collections. Lean body mass (LBM) was calculated from the Cr production. Serum albumin concentration was measured. Results The ratio of measured/predicted Cr production correlated positively and significantly with weekly KTN urea, the protein equivalent of nitrogen appearance (PNA), weekly Cr clearance, and LBM. There was a decline in serum albumin concentration at ratios greater than 1.24, supporting the opinions of previous authors who have suggested that ratios greater than 1.24 are highly suggestive of noncompliance with the dialysis prescription. Defining noncompliance as a ratio greater than 1.24 implied that at least 5% of the female and 17% of the male patients were noncompliant. Conclusions Declining serum albumin concentrations at higher ratios of measured/predicted Cr production support the opinion that this is an index of noncompliance. However, not all noncompliant patients necessarily have a ratio greater than 1.24. Weekly KTN urea, weekly Ccr and LBM are all artifactually increased by “washout effects” if all exchanges are done only or mainly on the collection day.

Systemic sclerosis portends increased risk of conduction and rhythm abnormalities at diagnosis and during disease course: A US population-based cohort

2021 ◽  
pp. 239719832110340
Author(s):  
Yasser A Radwan ◽  
Reto D Kurmann ◽  
Avneek S Sandhu ◽  
Edward A El-Am ◽  
Cynthia S Crowson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Hypertension ◽  
Systemic Sclerosis ◽  
Confidence Interval ◽  
Cumulative Incidence ◽  
Disease Onset ◽  
Population Based ◽  
Hazard Ratio ◽  
Conduction Disorders ◽  
Increased Risk

Objectives: To study the incidence, risk factors, and outcomes of conduction and rhythm disorders in a population-based cohort of patients with systemic sclerosis versus nonsystemic sclerosis comparators. Methods: An incident cohort of patients with systemic sclerosis (1980–2016) from Olmsted County, MN, was compared to age- and sex-matched nonsystemic sclerosis subjects (1:2). Electrocardiograms, Holter electrocardiograms, and a need for cardiac interventions were reviewed to determine the occurrence of any conduction or rhythm abnormalities. Results: Seventy-eight incident systemic sclerosis cases and 156 comparators were identified (mean age 56 years, 91% female). The prevalence of any conduction disorder before systemic sclerosis diagnosis compared to nonsystemic sclerosis subjects was 15% versus 7% ( p = 0.06), and any rhythm disorder was 18% versus 13% ( p = 0.33). During a median follow-up of 10.5 years in patients with systemic sclerosis and 13.0 years in nonsystemic sclerosis comparators, conduction disorders developed in 25 patients with systemic sclerosis with cumulative incidence of 20.5% (95% confidence interval: 12.4%–34.1%) versus 28 nonsystemic sclerosis patients with cumulative incidence of 10.4% (95% confidence interval: 6.2%–17.4%) (hazard ratio: 2.57; 95% confidence interval: 1.48–4.45), while rhythm disorders developed in 27 patients with systemic sclerosis with cumulative incidence of 27.3% (95% confidence interval: 17.9%–41.6%) versus 43 nonsystemic sclerosis patients with cumulative incidence of 18.0% (95% confidence interval: 12.3%–26.4%) (hazard ratio: 1.62; 95% confidence interval: 1.00–2.64). Age, pulmonary hypertension, and smoking were identified as risk factors. Conclusion: Patients with systemic sclerosis have an increased risk of conduction and rhythm disorders both at disease onset and over time, compared to nonsystemic sclerosis patients. These findings warrant increased vigilance and screening for electrocardiogram abnormalities in systemic sclerosis patients with pulmonary hypertension.

scholarly journals Serum Albumin and Future Risk of Hip, Humeral, and Wrist Fractures in Caucasian Men: New Findings from a Prospective Cohort Study

2019 ◽  
Vol 28 (5) ◽  
pp. 401-409 ◽  
Author(s):  
Setor K. Kunutsor ◽  
Ari Voutilainen ◽  
Michael R. Whitehouse ◽  
Samuel Seidu ◽  
Jussi Kauhanen ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Area Under The Curve ◽  
Fracture Prevention ◽  
Albumin Concentration ◽  
Serum Albumin Concentration ◽  
Baseline Serum ◽  
Increased Risk ◽  
New Findings ◽  
Caucasian Men ◽  
Low Serum

Objective: Low serum albumin concentration is associated with poor health outcomes, but its relationship with the risk of fractures has not been reliably quantified. We aimed to assess the prospective association of serum albumin with the risk of fractures in a general population. Subjects and Methods: Baseline serum albumin concentrations were measured in 2,245 men aged 42–61 years in the Kuopio Is­chemic Heart Disease study. Hazard ratios (HRs) (95% confidence intervals) were calculated for incident fractures. Results: A total of 121 fractures (hip, humeral, or wrist) were recorded during a median follow-up of 25.6 years. The risk of fractures increased linearly below a serum albumin concentration of ∼48 g/L. The age-adjusted HR (95% CI) for fractures per 1 standard deviation lower serum albumin was 1.24 (1.05–1.48). On further adjustment for several conventional and emerging risk factors, the HR was attenuated to 1.21 (1.01–1.45). Comparing the bottom versus top quartile of serum albumin levels, the corresponding adjusted HRs were 2.48 (1.37–4.48) and 2.26 (1.23–4.14). The association of serum albumin with fracture risk did not differ substantially according to age, body mass index, blood pressure, physical activity, alcohol consumption, socioeconomic status, inflammation, prevalent diseases, and smoking. Serum albumin at a threshold of 41.5 g/L demonstrated an area under the curve of 0.5850. Conclusion: In middle-aged Caucasian men, low serum albumin is associated with an increased risk of future fractures. The potential relevance of serum albumin concentrations in fracture prevention and prediction deserves further evaluation.

scholarly journals Serum albumin concentration and risk of end-stage renal disease: the REGARDS study

2017 ◽  
Vol 33 (10) ◽  
pp. 1770-1777 ◽  
Author(s):  
Carl P Walther ◽  
Orlando M Gutiérrez ◽  
Mary Cushman ◽  
Suzanne E Judd ◽  
Joshua Lang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Disease ◽  
Serum Albumin ◽  
End Stage Renal Disease ◽  
Albumin Concentration ◽  
Serum Albumin Concentration ◽  
Lower Serum ◽  
Regards Study ◽  
Stage Renal Disease ◽  
End Stage

ABSTRACT Background Serum albumin concentration is a commonly available biomarker with prognostic value in many disease states. It is uncertain whether serum albumin concentrations are associated with incident end-stage renal disease (ESRD) independently of urine albumin-to-creatinine ratio (ACR). Methods A longitudinal evaluation was performed of a population-based community-living cohort from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Participants were ≥45 years of age at study entry and had serum albumin, creatinine, cystatin C and spot urine ACR measured at the baseline visit (n = 19 633). Estimated glomerular filtration rate (eGFR) was from the Chronic Kidney Disease Epidemiology Collaboration combined creatinine-cystatin C equation. Baseline serum albumin concentration was the predictor variable, and hazard ratios (HRs) for incident ESRD (from US Renal Data System linkage) were calculated in sequentially adjusted models. Results Age at study entry was 63.9 ± 9.7 years, 62% of the participants were female and 40% were black. Mean eGFR at baseline was 83.3 ± 20.8 mL/min/1.73 m2. Over a median 8-year follow-up, 1.2% (n = 236) developed ESRD. In models adjusted for baseline eGFR, ACR and other ESRD risk factors, the HR for incident ESRD was 1.16 [95% confidence interval (CI) 1.01–1.33] for each standard deviation (0.33 g/dL) lower serum albumin concentration. The HR comparing the lowest (<4 g/dL) and highest quartiles (≥4.4 g/dL) of serum albumin was 1.61 (95% CI 0.98–2.63). Results were qualitatively similar among participants with eGFR <60 and ≥60 mL/min/1.73 m2, and those with and without diabetes. Conclusions In community-dwelling US adults, lower serum albumin concentration is associated with higher risk of incident ESRD independently of baseline urine ACR, eGFR and other ESRD risk factors.

scholarly journals Association between Serum Albumin Concentration and Ketosis Risk in Hospitalized Individuals with Type 2 Diabetes Mellitus

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Po-Chung Cheng ◽  
Shang-Ren Hsu ◽  
Yun-Chung Cheng
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Serum Albumin ◽  
Medical Center ◽  
Albumin Concentration ◽  
Cerebrovascular Event ◽  
Serum Albumin Concentration ◽  
Cross Sectional

Objective.This study examined the association between serum albumin concentration and ketosis risk in hospitalized individuals with type 2 diabetes mellitus (T2DM).Methods. A retrospective cross-sectional study was conducted at a medical center in Taiwan. Inclusion criteria were endocrinology ward inpatients exceeding 21 years of age, with preexisting diagnosis of T2DM, and blood glucose above 13.9 millimoles per liter (mmol/L) at admission. Individuals without measurement of serum albumin, urine ketone, or hemoglobin A1C, or harboring active infection, myocardial infarction, cerebrovascular event, cirrhosis, malignancy, or overt proteinuria were excluded. Using serum albumin concentration below 3.0 grams per deciliter to define hypoalbuminemia, 151 hypoalbuminemic cases and 104 normoalbuminemic controls were enrolled. The presence of ketones in urine established ketosis.Results. The prevalence of ketonuria was 48% in hypoalbuminemic subjects compared to 30% in normoalbuminemic controls (odds ratio (OR): 2.15; 95% confidence interval (CI): 1.26–3.57;P=0.004). Moreover, among the 156 subjects with serum beta-hydroxybutyrate measurement in addition to urine ketone, 33% of the hypoalbuminemic individuals had ketonemia exceeding 3 mmol/L compared to 19% of those with normoalbuminemia (OR: 2.12, 95% CI: 0.99–4.48,P=0.051).Conclusions. Serum albumin concentration is inversely associated with ketosis risk in hospitalized individuals with T2DM.

Risk Factors for The First Episode of Peritonitis in Continuous Ambulatory Peritoneal Dialysis Patients in Pranangklao Hospital

2021 ◽  
Vol 104 (12) ◽  
pp. 1966-1970
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Laboratory Data ◽  
First Episode ◽  
Coagulase Negative Staphylococcus ◽  
Technical Failure ◽  
The Mean ◽  
Stage Renal Disease

Background: Continuous ambulatory peritoneal dialysis (CAPD) is a renal replacement therapy for end stage renal disease patients. Peritonitis is a common complication in CAPD patients leading cause of technical failure and patient mortality. Investigating the risk for the first episode of peritonitis could help to prevent and improve CAPD outcomes. Objective: To investigate the risk factors for the first episode of peritonitis in CAPD patients in Pranangklao Hospital. Materials and Methods: A single-center, retrospective descriptive study was conducted to evaluate patients undergoing peritoneal dialysis (PD). All incident CAPD patients between October 1, 2011 and March 1, 2021 were recruited. Baseline demographic, and clinical and laboratory data were collected from medical records. Results: In a cumulative 10,916.9 patient-months follow-up of the 411 CAPD patients, 227 were male and 184 were female. One hundred eightyeight (45.7%) patients presented the first episode of peritonitis. The mean age of peritonitis free group and first peritonitis group was 58.2 years and 56.7 years, respectively. The mean duration from starting CAPD to the first episode of peritonitis was 19.4 months. The average peritonitis rate was 0.26 episodes per year, or one episode per 46.84 patient-months. There were no significant differences in clinical characteristics and laboratory data between these two groups, except there were more diabetes mellitus in the infectious peritonitis group at 72.6% versus 62.8% (p=0.03). Coagulase-negative Staphylococcus was the most common organism causing peritonitis. The multivariate logistic regression showed that diabetes mellitus (OR 1.59, 95% CI 1.03 to 2.46, p=0.04) was the risk factors associated with peritonitis. Conclusion: Diabetes mellitus was the risk factor associated with the first episode of peritonitis. Therefore, special supervision should be provided to this group of patients by optimally controlling the diabetic conditions. Keywords: Continuous ambulatory peritoneal dialysis; First peritonitis episode; Risk factors

scholarly journals Gallstone Disease and the Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis of Observational Studies

2016 ◽  
Vol 106 (1) ◽  
pp. 21-27 ◽  
Author(s):  
S. Upala ◽  
A. Sanguankeo ◽  
V. Jaruvongvanich
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Cardiovascular Disease ◽  
Confidence Interval ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
Gallstone Disease ◽  
Hazard Ratio ◽  
Cross Sectional ◽  
Increased Risk

Objectives: Gallstone disease shares certain risk factors with cardiovascular disease, particularly metabolic risk factors. Patients with gallstone disease may be at increased risk of cardiovascular disease. Several recent studies exploring the effect of gallstone disease on cardiovascular disease outcomes demonstrated inconsistent results. Design: We conducted a systematic review and meta-analysis of cohort, case–control, and cross-sectional studies that compared the risk of developing cardiovascular disease events in patients with gallstone disease versus non-gallstone disease controls. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate the pooled hazard ratio, odd ratio, and 95% confidence interval. Results: Data were extracted from six studies involving 176,734 cases and 803,714 controls. The pooled hazard ratio of cardiovascular events in patients with gallstone disease was 1.28 (95% confidence interval: 1.23–1.33, I2 = 42%). The pooled odd ratio of cardiovascular events in patients with gallstone disease was 1.82 (95% confidence interval: 1.47–2.24, I2 = 68%). Conclusions: Our study demonstrated a statistically significant increase in the risk of cardiovascular disease among patients with gallstone disease.

Risk factors for wound complications and 30-day mortality after major lower limb amputations in patients with peripheral arterial disease

Vascular ◽  
2017 ◽  
Vol 26 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Koichi Morisaki ◽  
Terutoshi Yamaoka ◽  
Kazuomi Iwasa
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Major Amputation ◽  
Hazard Ratio ◽  
Wound Complications ◽  
Albumin Concentration ◽  
Knee Amputation ◽  
Peripheral Arterial

Purpose Risk factors for wound complications or 30-day mortality after major amputation in patients with peripheral arterial disease remain unclear. We investigated the outcomes of major amputation in patients with peripheral arterial disease. Methods Patients who underwent major amputation from 2008 to 2015 were retrospectively analyzed. The main outcome measures were risk factors for wound complications and 30-day mortality after major lower limb amputations. Major amputation was defined as above-knee amputation or below-knee amputation. Wound complications were defined as surgical site infection or wound dehiscence. Results In total, 106 consecutive patients underwent major amputation. The average age was 77.3 ± 11.2 years, 67.9% of patients had diabetes mellitus and 35.8% were undergoing hemodialysis. Patients who underwent primary amputation constituted 61.9% of the cohort, and the proportions of above-knee amputation and below-knee amputation were 66.9% and 33.1%, respectively. The wound complication rate was 13.3% overall, 10.3% in above-knee amputation, and 19.5% in below-knee amputation. Multivariate analysis showed that the risk factors for wound complications were female sex (hazard ratio, 4.66; 95% confidence interval, 1.40–17.3; P = 0.01) and below-knee amputation (hazard ratio, 4.36; 95% confidence interval, 1.20–17.6; P = 0.03). The 30-day mortality rate was 7.6%, pneumonia comprised the most frequent cause of 30-day mortality, followed by sepsis and cardiac death. Multivariate analysis showed that a low serum albumin concentration (hazard ratio, 3.87; 95% confidence interval, 1.12–16.3; P = 0.03) was a risk factor for 30-day mortality. Conclusions Female sex and below-knee amputation were risk factors for wound complications. A low serum albumin concentration was a risk factor for 30-day mortality after major amputation in Japanese patients with peripheral arterial disease.

scholarly journals Hospital-diagnosed infections before age 20 and risk of a subsequent multiple sclerosis diagnosis

Brain ◽  
2021 ◽  
Author(s):  
Yin Xu ◽  
Kelsi A Smith ◽  
Ayako Hiyoshi ◽  
Fredrik Piehl ◽  
Tomas Olsson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Sclerosis ◽  
Confidence Interval ◽  
Infectious Mononucleosis ◽  
Bacterial Infections ◽  
Hazard Ratio ◽  
Cns Infection ◽  
Cns Infections ◽  
Increased Risk ◽  
Multiple Sclerosis Diagnosis

Abstract The involvement of specific viral and bacterial infections as risk factors for multiple sclerosis has been studied extensively. However, whether this extends to infections in a broader sense is less clear and little is known about whether risk of a multiple sclerosis diagnosis is associated with other types and sites of infections, such as of the CNS. This study aims to assess if hospital-diagnosed infections by type and site before age 20 years are associated with risk of a subsequent multiple sclerosis diagnosis and whether this association is explained entirely by infectious mononucleosis, pneumonia, and CNS infections. Individuals born in Sweden between 1970–1994 were identified using the Swedish Total Population Register (n = 2,422,969). Multiple sclerosis diagnoses from age 20 years and hospital-diagnosed infections before age 20 years were identified using the Swedish National Patient Register. Risk of a multiple sclerosis diagnosis associated with various infections in adolescence (11–19 years) and earlier childhood (birth-10 years) was estimated using Cox regression, with adjustment for sex, parental socioeconomic position, and infection type. None of the infections by age 10 years were associated with risk of a multiple sclerosis diagnosis. Any infection in adolescence increased the risk of a multiple sclerosis diagnosis (hazard ratio 1.33, 95% confidence interval 1.21–1.46) and remained statistically significant after exclusion of infectious mononucleosis, pneumonia, and CNS infection (hazard ratio 1.17, 95% confidence interval 1.06–1.30). CNS infection in adolescence (excluding encephalomyelitis to avoid including acute disseminated encephalitis) increased the risk of a multiple sclerosis diagnosis (hazard ratio 1.85, 95% confidence interval 1.11–3.07). The increased risk of a multiple sclerosis diagnosis associated with viral infection in adolescence was largely explained by infectious mononucleosis. Bacterial infections in adolescence increased risk of a multiple sclerosis diagnosis, but the magnitude of risk reduced after excluding infectious mononucleosis, pneumonia and CNS infection (hazard ratio 1.31, 95% confidence interval 1.13–1.51). Respiratory infection in adolescence also increased risk of a multiple sclerosis diagnosis (hazard ratio 1.51, 95% confidence interval 1.30–1.75), but was not statistically significant after excluding infectious mononucleosis and pneumonia. These findings suggest that a variety of serious infections in adolescence, including novel evidence for CNS infections, are risk factors for a subsequent multiple sclerosis diagnosis, further demonstrating adolescence is a critical period of susceptibility to environmental exposures that raise the risk of a multiple sclerosis diagnosis. Importantly, this increased risk cannot be entirely explained by infectious mononucleosis, pneumonia, or CNS infections.

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