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    Please use this identifier to cite or link to this item: http://ir.cnu.edu.tw/handle/310902800/29759


    標題: Comparison of the impact of "fast decline" in residual renal function and "initial anuria" on long-term outcomes in capd patients
    作者: Lu, Yi-Hua
    Hwang, Jyh-Chang
    Jiang, Ming-Yan
    Wang, Charn-Ting
    貢獻者: 醫務管理系
    關鍵字: CAPD
    anuria
    residual renal function
    diabetes mellitus
    survival
    co-morbidity
    日期: 2015-03
    上傳時間: 2016-04-19 19:07:10 (UTC+8)
    出版者: Multimed Inc
    摘要: Background: Residual renal function (RRF) is pivotal to long-term outcomes, while rapid RRF decline (RRFD) is associated with mortality risk for continuous ambulatory peritoneal dialysis (CAPD) patients. This study was conducted to compare the impact of "initial anuria" and rapid RRFD on the long-term prognosis of CAPD patients.
    Method: According to the timing of anuria and the slope of RRFD, a total of 255 incident CAPD patients were divided into 3 groups. For the "anuria" group, anuria was detected from CAPD initiation and persisted for > 6 months (n = 27). Based on the median of the RRFD slope, the other 228 non-anuric patients were divided into a "slow decliner" group (n= 114), and a "rapid decliner" group (n = 114). The maximal observation period was 120 months.
    Results: Logistic regression tests indicated that the "anuria" group was associated with previous hemodialysis > 3 months (odds ratio [OR]: 8.52, 95% confidence interval [CI]: 3.12 -23.28), and female (OR: 0.29, 95% CI: 0.09 0.90), while the "fast decliner" group with higher Davies co-morbidity scores (DCS) (OR: 1.52; 95% CI: 1.08 -2.14), body mass index (BMI) (OR: 1.12; 95% CI: 1.04 -1.21), and male (OR: 1.12; 95% CI: 1.04 -1.21). After adjusting for DCS, the "fast decliner"group (hazard ratio [HR]: 0.37; 95% CI: 0.17 -0.80) showed a better outcome than that of the "anuria" group (reference = 1). Both baseline RRF (beta = -0.24; p < 0.001) and DCS (beta = -3.76; p < 0.001) showed inverse linear correlations to the slope of RRFD. From the Cox proportional analyses, higher baseline RRF (HR: 0.92; 95% CI: 0.88 -0.97) and higher slope of RRFD (slower decline in RRF) (HR: 0.90; 95% CI: 0.85 -0.96) were independent factors for less mortality risk in patients with DCS = 0. However, only a higher slope of RRFD (HR: 0.97; 95% CI: 0.94 -0.99) was significant for better survival in CAPD patients with DCS > 0.
    Conclusion: Compared to the baseline RRF, CAPD patients with co-morbidities that rapidly deteriorate RRFD are more crucially associated with long-term mortality risk.
    Appears in Collections:[醫務管理系(所)] 期刊論文

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