Icodextrin Is Associated With A Lower Mortality Rate In Peritoneal Dialysis Patients
Journal
Peritoneal Dialysis International
Journal Volume
39
Journal Issue
3
Pages
252-260
Date Issued
2019
Author(s)
Abstract
Background: Icodextrin (ICO) improves fluid removal in peritoneal dialysis (PD) patients. However, whether physiological benefits of ICO translate into patient survival remains unclear. We examine the association of ICO and clinical outcomes. Methods: We identified patients who initiated long-term PD from the National Health Insurance Research Database of Taiwan. We matched ICO users with non-users according to propensity score and survival status when ICO was prescribed. We utilized time-dependent analyses to avoid immortal time bias. Additional competing risk models were utilized for the outcomes except for death. The outcomes of interest were time to death, technique failure, peritonitis, major adverse cardiovascular events (MACE), and hospitalization. Results: A total of 4,914 PD patients were enrolled and 2,836 PD patients (57.7%) were identified as ICO users. The ICO users had significantly better overall survival (hazard ratio [HR] 0.74; 95% confidence interval [CI] 0.63 – 0.86), especially among early ICO users (HR 0.64; 95% CI 0.54 – 0.77, p value for interaction: 0.007). The ICO users were associated with higher risk of peritonitis (subdistribution HR 1.22, 95% CI 1.06 – 1.14) and hospitalization (subdistribution HR 1.14, 95% CI 1.05 – 1.24), considering competing risk of death. However, when considering ICO use as a time-varying covariate, ICO users shared similar risks for technique failure, peritonitis, MACE, and hospitalization as non-users. The effect of ICO on mortality was especially prominent among those early users. Conclusions: After adjustments for immortal time biases, ICO users were significantly associated with approximately 20% reduction in mortality, especially among early users. ? 2019 International Society for Peritoneal Dialysis. All rights reserved.
SDGs
Other Subjects
icodextrin; dialysis fluid; icodextrin; Article; Charlson Comorbidity Index; cohort analysis; controlled study; diabetes mellitus; drug use; dyslipidemia; female; follow up; gender; heart failure; hospitalization; human; hypertension; incidence; major clinical study; male; mortality rate; overall survival; peritoneal dialysis; peritonitis; prevalence; priority journal; survival; time of death; treatment free survival; adverse event; aged; cause of death; comparative study; factual database; middle aged; mortality; organization and management; peritoneal dialysis; peritonitis; procedures; proportional hazards model; public health; retrospective study; survival analysis; Taiwan; university hospital; Aged; Cause of Death; Cohort Studies; Databases, Factual; Dialysis Solutions; Female; Hospitals, University; Humans; Icodextrin; Male; Middle Aged; Mortality; National Health Programs; Peritoneal Dialysis; Peritonitis; Proportional Hazards Models; Retrospective Studies; Survival Analysis; Taiwan
Publisher
Multimed Inc.
Type
journal article