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Low prognostic nutritional index associated with cardiovascular disease mortality in incident peritoneal dialysis patients

  • Nephrology - Original Paper
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Abstract

Purpose

The prognostic nutritional index (PNI), a variable based on serum albumin concentration and total lymphocyte count in peripheral blood, is reported as a predictor of mortality in a variety of malignant tumor population. This study is aimed to evaluate whether PNI has prognostic value in patients on peritoneal dialysis (PD).

Methods

This was a single-center, retrospective observational cohort study conducted in incident PD patients from January 1, 2006 to June 30, 2014, and followed until June 30, 2015. The associations of PNI levels with mortality were evaluated by Kaplan–Meier method and Cox proportional hazards models.

Results

A total of 345 patients were included in this study. Median PNI level at baseline was 40.7 (range: 18.8–75.5) for all patients. During follow-up, 59 (17.1%) died during follow-up, among which 31 (52.5%) were due to cardiovascular diseases (CVD). In crude analysis, the patients with low PNI had a significant increase risk of CVD and all-cause mortality [hazard ratio (HR) 3.07, 95% confidence interval (CI) 1.51–6.25 and HR 2.18, 95% CI 1.28–3.72, respectively)]. After adjusting age, Davies comorbidity score, hemoglobin and leukocytes, the patients with low PNI still had a significant increased risk of CVD mortality (HR 2.37, 95% CI 1.10–5.12). However, there was no significant difference in risk of all-cause mortality (HR 1.72, 95% CI 0.97–3.06).

Conclusions

Low PNI at initiation of PD was independently associated with an increased CVD mortality.

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Acknowledgements

We thank all the participants including research PD nurses and patients in our peritoneal dialysis center, Chen Zhao and Shaofei Jin for their assistance in statistical analyses.

Funding

This work was funded by Natural Science Foundation of Guangdong Province, China (No. 2014A030310065), National Natural Science Foundation of China (No. 81600624 and 81673792), the Science and Technology Planning Project of Guangdong Province, China (Nos. 2013B021800149, 2014A020210011 and 2015A020211012) and the Science and Technology Planning Project of Guangzhou, China (No. 201510010137).

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    Authors and Affiliations

    1. Department of Nephrology, Zhujiang Hospital of Southern Medical University, Guangzhou, 510280, China

      Fenfen Peng, Wenjing Chen, Weidong Zhou, Peilin Li, Hongxin Niu, Yihua Chen, Yan Zhu & Haibo Long

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    1. Fenfen Peng
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    2. Wenjing Chen
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    3. Weidong Zhou
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    4. Peilin Li
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    5. Hongxin Niu
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    6. Yihua Chen
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    7. Yan Zhu
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    8. Haibo Long
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    Correspondence to Haibo Long.

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    The authors declare that they have no conflict of interest.

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    Fenfen Peng, Wenjing Chen and Weidong Zhou have contributed equally to this study.

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    Peng, F., Chen, W., Zhou, W. et al. Low prognostic nutritional index associated with cardiovascular disease mortality in incident peritoneal dialysis patients. Int Urol Nephrol 49, 1095–1101 (2017). https://doi.org/10.1007/s11255-017-1531-0

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