Analysis of clinically related factors influencing functional performance of peritoneal dialysis patients

Objective The functional performance and related factors are rarely known in peritoneal dialysis (PD) patients. This study aimed to evaluate functional performance of PD patients by using the Karnofsky Performance Status Scale (KPSS) scores, and to investigate its relationship with clinical parameters. Methods A total 491 prevalent PD patients at the age of 18-80 from two hospital-facilitated PD centers (The Tianjin First Central Hospital, from March 2008 to April 2017; Gaoxiong Changgeng Memorializing Hospital, Taiwan, from February 1999 to July 2009) were recruited for retrospective analysis. These patients had received regularly PD treatment for at least 3 months. The collected data included demographic characteristics, blood biochemical parameters, comorbidities and PD related parameters. KPSS score was used to assess functional performance. The subjects were further stratified into high (>80, n=121) and low (<70, n=121) KPSS cohorts by propensity score matching through gender, age and PD age. By multivariate logistic regression analyses, odds ratios (ORs) of various clinical parameters to low KPSS scores were calculated for low KPSS scores. Results Compared to the patients with high KPSS scores, the ones with low KPSS scores showed predominant complicated diabetes, higher Charlson index, lower serum albumin and cholesterol levels, lower urea nitrogen clearance (Kt/V) (total and residual renal), lower creatinine clearance, decreased normalized protein catabolic rate (nPCR). By multivariate analyses, complicated diabetes (OR 3.75; 95%CI 1.43~9.87,P=0.007) and blood urea nitrogen (BUN) (OR 1.02; 95%CI 1.01~1.04,P=0.004) showed risk factors for low KPSS scores in PD patients. In contrast, high serum albumin (OR 0.30; 95%CI 0.12~0.79,P=0.014) and nPCR (OR 0.08; 95%CI 0.01~0.41,P=0.003) exhibited a protective factor for low KPSS scores in PD patients.Conclusions PD patients with low functional performance are significantly associated with a history of diabetes and BUN level. High serum albumin and nPCR are associated with decreased risk for low functional performance in PD patients.