Abstract：
The advantages of an incremental dialysis start are not fully clear. We aimed to evaluate the association of incremental initiation of peritoneal dialysis with mortality.
Incident peritoneal dialysis patients with a catheter placed at our hospital between 2008 and 2017 were included. All patients were followed up until December 31, 2019. Patients were categorized into different groups according to the initial daily dialysis exchanges, and were matched at a ratio of 1:2 with propensity score matching. Multiple variables including age, sex, residual kidney function, urine volume, hemoglobin, serum albumin and other important variables were included for the matching. Primary outcomes were all-cause and cardiovascular mortality.
A total of 1315 patients with a mean age of 45.9 years were enrolled. The mean glomerular filtration rate was 4.32 ml/min/1.73 m2 at start of dialysis. Two hundred eighty-five patients in the incremental group and 502 in the full dose group were matched for age, sex, residual kidney function, urine volume, hemoglobin, serum albumin and other important variables. Patient survival and cardiovascular event-free survival were similar between the two groups. However, during the first 6 years of peritoneal dialysis, patients in the incremental group had better survival (P = 0.011) and cardiovascular event-free survival (P = 0.044) than the full dose group, while such advantages disappeared when dialysis vintage became longer. Further analysis showed that the incremental group (vs full dose dialysis) had a 39% lower risk (95% CI 0.42-0.90, P = 0.012) of all-cause mortality and a 41% decreased risk (95% CI 0.35-0.99, P = 0.047) of cardiovascular mortality during the first 6 years of dialysis. Additionally, the cumulative hazard for anuria was significantly lower in the incremental group versus the full dose group (P = 0.006).
Our study shows a time-related survival advantage for incremental peritoneal dialysis patients, suggesting that an incremental regimen for starting peritoneal dialysis is feasible and is not associated with worse outcomes. Graphical Abstract presenting schematically the measurements of the solvation response function by processing the relevant streak camera images and the time-correlated photon counting (TCSPC) data and appropriately combining them together.
Incident peritoneal dialysis patients with a catheter placed at our hospital between 2008 and 2017 were included. All patients were followed up until December 31, 2019. Patients were categorized into different groups according to the initial daily dialysis exchanges, and were matched at a ratio of 1:2 with propensity score matching. Multiple variables including age, sex, residual kidney function, urine volume, hemoglobin, serum albumin and other important variables were included for the matching. Primary outcomes were all-cause and cardiovascular mortality.
A total of 1315 patients with a mean age of 45.9 years were enrolled. The mean glomerular filtration rate was 4.32 ml/min/1.73 m2 at start of dialysis. Two hundred eighty-five patients in the incremental group and 502 in the full dose group were matched for age, sex, residual kidney function, urine volume, hemoglobin, serum albumin and other important variables. Patient survival and cardiovascular event-free survival were similar between the two groups. However, during the first 6 years of peritoneal dialysis, patients in the incremental group had better survival (P = 0.011) and cardiovascular event-free survival (P = 0.044) than the full dose group, while such advantages disappeared when dialysis vintage became longer. Further analysis showed that the incremental group (vs full dose dialysis) had a 39% lower risk (95% CI 0.42-0.90, P = 0.012) of all-cause mortality and a 41% decreased risk (95% CI 0.35-0.99, P = 0.047) of cardiovascular mortality during the first 6 years of dialysis. Additionally, the cumulative hazard for anuria was significantly lower in the incremental group versus the full dose group (P = 0.006).
Our study shows a time-related survival advantage for incremental peritoneal dialysis patients, suggesting that an incremental regimen for starting peritoneal dialysis is feasible and is not associated with worse outcomes. Graphical Abstract presenting schematically the measurements of the solvation response function by processing the relevant streak camera images and the time-correlated photon counting (TCSPC) data and appropriately combining them together.
摘要：
背景：增量透析开始的优点尚不完全清楚。我们旨在评估腹膜透析的增量开始与死亡率的相关性。
方法：纳入2008年至2017年在我院放置导管的意外腹膜透析患者。所有患者均随访至2019年12月31日。根据最初的每日透析交换将患者分为不同的组，并以1:2的比例与倾向评分匹配。包括年龄在内的多个变量，性别,残余肾功能，尿量,血红蛋白,纳入血清白蛋白和其他重要变量进行匹配.主要结局是全因死亡率和心血管死亡率。
结果：共纳入1315例患者，平均年龄45.9岁。透析开始时的平均肾小球滤过率为4.32ml/min/1.73m2。增量组的二百八十五名患者和全剂量组的502名患者的年龄相匹配，性别,残余肾功能，尿量,血红蛋白,血清白蛋白和其他重要变量。两组患者生存率和无心血管事件生存率相似。然而,在腹膜透析的前6年，增量组患者的生存率(P=0.011)和无心血管事件生存率(P=0.044)均优于全剂量组,而当透析年份变得更长时，这些优势就消失了。进一步分析显示，在透析的前6年中，增量组（与全剂量透析相比）的全因死亡率风险降低了39％（95％CI0.42-0.90，P=0.012），心血管死亡率风险降低了41％（95％CI0.35-0.99，P=0.047）。此外,与全剂量组相比,增量组无尿的累积风险显著更低(P=0.006).
结论：我们的研究显示增加腹膜透析患者的时间相关生存优势，提示开始腹膜透析的增量方案是可行的,且与更差的结局无关.图形摘要通过处理相关的条纹相机图像和时间相关的光子计数（TCSPC）数据并将它们适当地组合在一起，示意性地呈现了溶剂化响应函数的测量。
方法：纳入2008年至2017年在我院放置导管的意外腹膜透析患者。所有患者均随访至2019年12月31日。根据最初的每日透析交换将患者分为不同的组，并以1:2的比例与倾向评分匹配。包括年龄在内的多个变量，性别,残余肾功能，尿量,血红蛋白,纳入血清白蛋白和其他重要变量进行匹配.主要结局是全因死亡率和心血管死亡率。
结果：共纳入1315例患者，平均年龄45.9岁。透析开始时的平均肾小球滤过率为4.32ml/min/1.73m2。增量组的二百八十五名患者和全剂量组的502名患者的年龄相匹配，性别,残余肾功能，尿量,血红蛋白,血清白蛋白和其他重要变量。两组患者生存率和无心血管事件生存率相似。然而,在腹膜透析的前6年，增量组患者的生存率(P=0.011)和无心血管事件生存率(P=0.044)均优于全剂量组,而当透析年份变得更长时，这些优势就消失了。进一步分析显示，在透析的前6年中，增量组（与全剂量透析相比）的全因死亡率风险降低了39％（95％CI0.42-0.90，P=0.012），心血管死亡率风险降低了41％（95％CI0.35-0.99，P=0.047）。此外,与全剂量组相比,增量组无尿的累积风险显著更低(P=0.006).
结论：我们的研究显示增加腹膜透析患者的时间相关生存优势，提示开始腹膜透析的增量方案是可行的,且与更差的结局无关.图形摘要通过处理相关的条纹相机图像和时间相关的光子计数（TCSPC）数据并将它们适当地组合在一起，示意性地呈现了溶剂化响应函数的测量。
