The centre-calculated cutoff value is better for identifying fast peritoneal solute transfer of patients on peritoneal dialysis than the traditional value: a retrospective cohort study
Jing Guo, Ruihua Liu, Yuan Peng, Chunyan Yi, Haishan Wu, Hongjian Ye, Jianxiong Lin, Xiangwen Diao, Fengxian Huang, Haiping Mao, Qunying Guo, Xiao Yang- Transplantation
- Nephrology
Abstract
Background
The mean 4-h dialysate to plasma ratio of creatinine (4-h D/Pcr) is a vital cutoff value for recognising the fast peritoneal solute transfer rate (PSTR) in patients on peritoneal dialysis (PD); however, it shows a noticeable centre effect. We aimed to investigate our centre-calculated cutoff value (CCV) of 4-h D/Pcr and compare it with the traditional cutoff value (TCV) (0.65).
Methods
In this study, we enrolled incident PD patients at our centre from 2008 to 2019, and divided them into fast or non-fast PSTR groups according to baseline 4-h D/Pcr based CCV or TCV. We compared the efficiency of the fast PSTR recognised by two cutoff values in predicting mortality, ultrafiltration (UF) insufficiency and technical survival.
Results
In total, 1905 patients were enrolled, with a mean 4-h D/Pcr of 0.71 ± 0.11. Compared with TCV (0.65), CCV (0.71) showed superiority in predicting mortality of PD patients (hazard ratio [HR] 1.27 [95% confidence interval [CI] 1.02–1.59] vs. HR 1.24 [95% CI 0.97–1.59]). The odds ratio (OR) of the fast PSTR in centre classification was slightly higher than traditional classification in predicting UF insufficiency (OR 1.67 [95% CI 1.25–2.24] vs. OR 1.60 [95% CI 1.15–2.22]). Additionally, the restricted cubic splines (RCS) demonstrated that 4-h D/Pcr has an S-shape association with mortality and UF insufficiency, and the inflection points of 4-h D/Pcr were 0.71 (equal to CCV).
Conclusions
The CCV of 4-h D/Pcr for identifying fast PSTR was 0.71. It was superior to TCV in predicting mortality and UF insufficiency.