Background and hypothesis:Iron metabolism markers, such as transferrin saturation (TSAT) and ferritin, are crucial in anemia management in patients with CKD and those undergoing dialysis, yet optimal levels remain unelucidated. Methods:We conducted a prospective multicenter cohort study using data from the nationwide Peritoneal Dialysis Telemedicine-based Management Platform (PDTAP) to analyze TSAT, ferritin, and hemoglobin (Hb) levels, and their associations with mortality in the peritoneal dialysis (PD) population. Results:Our study included 4429 PD patients, analyzing data through restricted cubic splines and Cox regression models, adjusted for multiple confounders. Non-linear associations between Hb levels and TSAT/ferritin were observed. Hb levels increased with TSAT up to 40%, then plateaued, whereas ferritin levels increased with the decline of Hb. Further, ferritin levels above 200 ng/mL were independently linked to increased mortality risk [hazard ratio (HR) 1.207, 95% confidence interval (CI) 1.134-1.286], with this effect decreasing as high-sensitivity C-reactive protein levels rose. This risk was notably significant in patients with a history of cardiovascular disease. A ferritin/Hb ratio >2 was associated with increased risk of mortality after adjusting for demographic, nutritional factors and erythropoiesis agents (HR 1.219, 95% CI 1.144-1.299). The ferritin/Hb ratio demonstrated superior predictive ability for iron responsiveness compared with ferritin alone. Conclusion:Serum ferritin level exceeding 200 ng/mL was indepently associated with a higher risk of martality in Chinese PD population. Monitoring the ferritin/Hb ratio may help assess the relative iron content in the body and provide reference for iron supplementation among patients undergoing PD.

Although more and more cardiovascular risk factors have been verified in peritoneal dialysis (PD) populations in different countries and regions, it is still difficult for clinicians to accurately and individually predict death in the near future. We aimed to develop and validate machine learning-based models to predict near-term all-cause and cardiovascular death. Machine learning models were developed among 7539 PD patients, which were randomly divided into a training set and an internal test set by five random shuffles of 5-fold cross-validation, to predict the cardiovascular death and all-cause death in 3 months. We chose objectively collected markers such as patient demographics, clinical characteristics, laboratory data, and dialysis-related variables to inform the models and assessed the predictive performance using a range of common performance metrics, such as sensitivity, positive predictive values, the area under the receiver operating curve (AUROC), and the area under the precision recall curve. In the test set, the CVDformer models had a AUROC of 0.8767 (0.8129, 0.9045) and 0.9026 (0.8404, 0.9352) and area under the precision recall curve of 0.9338 (0.8134,0.9453) and 0.9073 (0.8412, 0.9164) in predicting near-term all-cause death and cardiovascular death, respectively. The CVDformer models had high sensitivity and positive predictive values for predicting all-cause and cardiovascular deaths in 3 months in our PD population. Further calibration is warranted in the future.

Hypokalemia has been associated with an increased risk of peritoneal dialysis (PD)-associated peritonitis. However, hypokalemia is commonly associated with malnutrition, inflammation, and severe coexisting comorbidities, which thus are suspected of being potential confounders. This study was aimed at testing whether hypokalemia was independently associated with the occurrence and prognosis of PD-associated peritonitis. A national-level dataset from the Peritoneal Dialysis Telemedicine-assisted Platform Cohort (PDTAP) Study was used to explore the independent association of serum potassium with PD-associated peritonitis. Unmatched and propensity score-adjusted multivariate competing risk models, as well as univariate competing risk models following 1:1 propensity score matching, were conducted to balance potential biases between patients with and without hypokalemia. The association between potassium levels prior to peritonitis and treatment failure due to peritonitis was also investigated. During a median follow-up of 25.7 months in 7220 PD patients, there was a higher incidence of peritonitis in patients with serum potassium below 4.0 mmol/L compared to those with higher serum levels (677 [0.114/patient-year] vs. 914 [0.096/patient-year], P = 0.001). After adjusting for demographics, laboratory tests, residual renal function, and medication use, baseline potassium levels below 4.0 mmol/L were not linked to an increased risk of peritonitis, with a hazard ratio of 0.983 (95

ABSTRACT Background To explore the cut-off values of haemoglobin (Hb) on adverse clinical outcomes in incident peritoneal dialysis (PD) patients based on a national-level database. Methods The observational cohort study was from the Peritoneal Dialysis Telemedicine-assisted Platform (PDTAP) dataset. The primary outcomes were all-cause mortality, major adverse cardiovascular events (MACE) and modified MACE (MACE+). The secondary outcomes were the occurrences of hospitalization, first-episode peritonitis and permanent transfer to haemodialysis (HD). Results A total of 2591 PD patients were enrolled between June 2016 and April 2019 and followed up until December 2020. Baseline and time-averaged Hb <100 g/l were associated with all-cause mortality, MACE, MACE+ and hospitalizations. After multivariable adjustments, only time-averaged Hb <100 g/l significantly predicted a higher risk for all-cause mortality {hazard ratio [HR] 1.83 [95% confidence interval (CI) 1.19–281], P = .006}, MACE [HR 1.99 (95% CI 1.16–3.40), P = .012] and MACE+ [HR 1.77 (95% CI 1.15–2.73), P = .010] in the total cohort. No associations between Hb and hospitalizations, transfer to HD and first-episode peritonitis were observed. Among patients with Hb ≥100 g/l at baseline, younger age, female, use of iron supplementation, lower values of serum albumin and renal Kt/V independently predicted the incidence of Hb <100 g/l during the follow-up. Conclusion This study provided real-world evidence on the cut-off value of Hb for predicting poorer outcomes through a nation-level prospective PD cohort.

Introduction: Telemedicine (TM) has shown to provide potential benefits on clinical outcomes in patients with chronic kidney disease but limited evidences published in the peritoneal dialysis (PD) population. This study aimed to explore the long-term effects of TM on the mortality and technique failure. Methods: The Peritoneal Dialysis Telemedicine-assisted Platform Cohort Study (PDTAP Study) was conducted prospectively in 27 hospitals in China since 2016. Patient and practice data were collected through the doctor-end of the TM app (Manburs) for all participants. TM including self-monitoring records, on-line education materials, and real-time physician-patient contact was only performed for the patient-end users of the Manburs. The primary outcome was all-cause mortality. The secondary outcomes were cause-specific mortality and all-cause and cause-specific permanent transfer to hemodialysis. Results: A total of 7,539 PD patients were enrolled between June 2016 and April 2019, with follow-up till December 2020. Patients were divided into two cohorts: TM group (39.1%) and non-TM group (60.9%). A propensity score was used to create 2,160 matched pairs in which the baseline covariates were well-balanced. There were significantly lower risks of all-cause mortality (HR 0.59 [0.51, 0.67], p < 0.001), CVD mortality (HR 0.59 [0.49, 0.70], p < 0.001), all-cause transfer to hemodialysis (0.57 [0.48, 0.67], p < 0.001), transfer to hemodialysis from PD-related infection (0.67 [0.51, 0.88], p = 0.003), severe fluid overload (0.40 [0.30, 0.55], p < 0.001), inadequate solute clearance (0.49 [0.26, 0.92], p = 0.026), and catheter-related noninfectious complications (0.41 [0.17, 0.97], p = 0.041) in the TM group compared with the non-TM group. Conclusion: This study indicated real-world associations between TM usage and reduction in patient survival and technique survival through a multicenter prospective cohort.

Objectives: The primary objective of the Peritoneal Dialysis Telemedicine-assisted Platform Cohort (PDTAP) Study is to explore potential predictors and their effects on patient survival, technique survival, and the occurrence of infectious and noninfectious complications. Design: The PDTAP study is a national-level cohort study in China. A newly developed PD telemedicine application provided a unique and convenient way to collect multicenter, structured data across units. Setting: The PDTAP study was underway in 27 hospitals from 14 provinces located at 7 geographical regions (northwest, northeast, north, central, southwest, southeast, and south) in China. Participants: Our study aims to enroll at least 7000 adult patients with end-stage renal disease receiving PD. Methods: Approval has been obtained through the ethics committees of all hospitals. All participants signed the informed consent form after the center had received ethics board approval in accordance with the Declaration of Helsinki. Main outcome measures: Patient survival, technique survival, hospitalization, and the occurrence of infectious and noninfectious complications. Conclusions: The PDTAP study aims to explore potential predictors and their effects on patient survival, technique survival, and infectious and noninfectious complications using a newly developed PD telemedicine system to collect multicenter, structured data in real-world practice. Substantial and transformable findings in relation to PD practices were expected. This study also developed a national-level infrastructure for further collaboration and ancillary investigation.