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Effect of Serum Albumin Changes on Mortality in Patients with Peritoneal Dialysis: A Joint Modeling Approach and Personalized Dynamic Risk Predictions

Peritoneal dialysis (PD) is a frequently used and growing therapy for end-stage renal diseases (ESRD). Survival analysis of PD patients is an ongoing research topic in the field of nephrology. Several biochemical parameters (e.g., serum albumin, creatinine, and blood urea nitrogen) are measured repe...

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Autores principales: Basol, Merve, Goksuluk, Dincer, Sipahioglu, Murat H., Karaagaoglu, Ergun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8319732/
https://www.ncbi.nlm.nih.gov/pubmed/34337034
http://dx.doi.org/10.1155/2021/6612464
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author Basol, Merve
Goksuluk, Dincer
Sipahioglu, Murat H.
Karaagaoglu, Ergun
author_facet Basol, Merve
Goksuluk, Dincer
Sipahioglu, Murat H.
Karaagaoglu, Ergun
author_sort Basol, Merve
collection PubMed
description Peritoneal dialysis (PD) is a frequently used and growing therapy for end-stage renal diseases (ESRD). Survival analysis of PD patients is an ongoing research topic in the field of nephrology. Several biochemical parameters (e.g., serum albumin, creatinine, and blood urea nitrogen) are measured repeatedly in the follow-up period; however, baseline or averaged values are primarily associated with mortality. Although this strategy is not incorrect, it leads to information loss, resulting in erroneous conclusions and biased estimates. This retrospective study used the trajectory of common renal function indexes in PD patients and mainly investigated the association between serum albumin change and mortality. Furthermore, we considered patient-specific variability in serum albumin change and obtained personalized dynamic risk predictions for selected patients at different follow-up thresholds to investigate the effect of serum albumin trajectories on patient-specific mortality. We included 417 patients from the Erciyes University Nephrology Department whose data were retrospectively collected using medical records. A joint modeling approach for longitudinal and survival data was used to investigate the relationship between serum albumin trajectory and mortality of PD patients. Results showed that averaged serum albumin levels were not associated with mortality. However, serum albumin change was significantly and inversely associated with mortality (HR: 2.43, 95% CI: 1.48 to 4.16). Risk of death was positively associated with peritonitis rate, hemodialysis history, and the total number of comorbid and renal diseases with hazard ratios 1.74, 3.21, and 1.41. There was also significant variability between patients. The personalized risk predictions showed that overall survival estimates were not representative for all patients. Using the patient-specific trajectories provided better survival predictions within the follow-up period as more data become available in serum albumin levels. In conclusion, using the trajectory of risk predictors via an appropriate statistical method provided better predictive accuracy and prevented biased findings. We also showed that personalized risk predictions were much informative than overall estimations in the presence of significant patient variability. Furthermore, personalized estimations may play an essential role in monitoring and managing patients during the follow-up period.
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spelling pubmed-83197322021-07-31 Effect of Serum Albumin Changes on Mortality in Patients with Peritoneal Dialysis: A Joint Modeling Approach and Personalized Dynamic Risk Predictions Basol, Merve Goksuluk, Dincer Sipahioglu, Murat H. Karaagaoglu, Ergun Biomed Res Int Research Article Peritoneal dialysis (PD) is a frequently used and growing therapy for end-stage renal diseases (ESRD). Survival analysis of PD patients is an ongoing research topic in the field of nephrology. Several biochemical parameters (e.g., serum albumin, creatinine, and blood urea nitrogen) are measured repeatedly in the follow-up period; however, baseline or averaged values are primarily associated with mortality. Although this strategy is not incorrect, it leads to information loss, resulting in erroneous conclusions and biased estimates. This retrospective study used the trajectory of common renal function indexes in PD patients and mainly investigated the association between serum albumin change and mortality. Furthermore, we considered patient-specific variability in serum albumin change and obtained personalized dynamic risk predictions for selected patients at different follow-up thresholds to investigate the effect of serum albumin trajectories on patient-specific mortality. We included 417 patients from the Erciyes University Nephrology Department whose data were retrospectively collected using medical records. A joint modeling approach for longitudinal and survival data was used to investigate the relationship between serum albumin trajectory and mortality of PD patients. Results showed that averaged serum albumin levels were not associated with mortality. However, serum albumin change was significantly and inversely associated with mortality (HR: 2.43, 95% CI: 1.48 to 4.16). Risk of death was positively associated with peritonitis rate, hemodialysis history, and the total number of comorbid and renal diseases with hazard ratios 1.74, 3.21, and 1.41. There was also significant variability between patients. The personalized risk predictions showed that overall survival estimates were not representative for all patients. Using the patient-specific trajectories provided better survival predictions within the follow-up period as more data become available in serum albumin levels. In conclusion, using the trajectory of risk predictors via an appropriate statistical method provided better predictive accuracy and prevented biased findings. We also showed that personalized risk predictions were much informative than overall estimations in the presence of significant patient variability. Furthermore, personalized estimations may play an essential role in monitoring and managing patients during the follow-up period. Hindawi 2021-07-21 /pmc/articles/PMC8319732/ /pubmed/34337034 http://dx.doi.org/10.1155/2021/6612464 Text en Copyright © 2021 Merve Basol et al. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Basol, Merve
Goksuluk, Dincer
Sipahioglu, Murat H.
Karaagaoglu, Ergun
Effect of Serum Albumin Changes on Mortality in Patients with Peritoneal Dialysis: A Joint Modeling Approach and Personalized Dynamic Risk Predictions
title Effect of Serum Albumin Changes on Mortality in Patients with Peritoneal Dialysis: A Joint Modeling Approach and Personalized Dynamic Risk Predictions
title_full Effect of Serum Albumin Changes on Mortality in Patients with Peritoneal Dialysis: A Joint Modeling Approach and Personalized Dynamic Risk Predictions
title_fullStr Effect of Serum Albumin Changes on Mortality in Patients with Peritoneal Dialysis: A Joint Modeling Approach and Personalized Dynamic Risk Predictions
title_full_unstemmed Effect of Serum Albumin Changes on Mortality in Patients with Peritoneal Dialysis: A Joint Modeling Approach and Personalized Dynamic Risk Predictions
title_short Effect of Serum Albumin Changes on Mortality in Patients with Peritoneal Dialysis: A Joint Modeling Approach and Personalized Dynamic Risk Predictions
title_sort effect of serum albumin changes on mortality in patients with peritoneal dialysis: a joint modeling approach and personalized dynamic risk predictions
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8319732/
https://www.ncbi.nlm.nih.gov/pubmed/34337034
http://dx.doi.org/10.1155/2021/6612464
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