대한신장학회

논문분류	춘계학술대회 초록집
제목	The change of peritoneal protein clearance is an independent risk factor for predicting mortality in a large cohort of PD patients with peritonitis
저자	Kyoung sook PARK1, Song eun KIM2, Tae ik CHANG2, Sug kyun SHIN2, *Ea wha KANG2
출판정보	2017; 2017(1):
키워드	Peritoneal protein clearance, peritoneal dialysis related peritonitis, mortality
초록	Objectives : The relationship between peritoneal protein clearance (PPC), representing large pore flow, and mortality has been controversial because of susceptibility of PPC influenced by peritonitis in peritoneal dialysis (PD)- patients . And, the long-term follow-up and large study still have not been. Therefore, by following the change of PPC, we investigated the prognostic value of PPC for predicting all-cause mortality in patients with or without PD peritonitis. Methods : This prospective, observational study included a total of 332 patients who initiated PD at NHIS Ilsan Hospital, from January 2000 to December 2009. PPC was measured from 24 hours-PD effluent at initiation PD and after 2 years. We divided the patients into two groups according to presence of peritonitis event within PPC follow-up period; Group1, no peritonitis (N=127); Group 2, peritonitis (N=205). Cox proportional hazard analysis was performed to investigate the association of PPC with all-cause mortality in patients with or without peritonitis. Results : Among a total 332 of incident PD patients, 174 (52.4%) was male and 164 (49.4%) was diabetes mellitus (DM). The PPC levels trend to increase only in group 2 (86.56mg/d to 93.49mg/d, p = 0.099 vs. 85.38mg/d to 80.15 mg/d, p = 0.45 in group I). Correlation analyses revealed that PPC was positively correlated with frequency of peritonitis (r = 0.123, p = 0.025), the presence of DM (r = 0.227, p < 0.001) and congestive heart failure (CHF) (r = 0.130, p = 0.018). While, PPC was inversely correlated with initial serum albumin (r = - 0.296, p < 0.001). During a median follow-up duration of 45 months, 103 patients were died (31.0%). In multivariate Cox proportional hazard analysis, PPC at 2years later was an independent risk factor in only group 2 [Hazard Ratio (HR) = 1.007, confidential interval (CI) = 1.002-1.012, P = 0.004)]. Moreover, increasing of ΔPPC was a significant independent predictor of mortality in only group 2 (HR = 1.005, CI = 1.000-1.009, P = 0.032), even after adjusted with age, serum albumin, DM, CHF, frequency of peritonitis and Creactive protein. Conclusions : The change of PPC was a significant prognostic factor for allcause mortality in only PD patients with peritonitis. Serial measurement of PPC could be useful tool for predicting survival, especially in patients with PD peritonitis.
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