Serum creatinine level, a surrogate of muscle mass, predicts mortality in peritoneal dialysis patients

Background: In hemodialysis patients, higher serum creatinine (Cr) concentration represents larger muscle mass and predicts greater survival. However, this association remains uncertain in peritoneal dialysis (PD) patients.

Methods: In a cohort of 10 896 PD patients enrolled from 1 July 2001 to 30 June 2006, the association of baseline serum Cr level and change during the first 3 months after enrollment with all-cause mortality was examined.

Results: The cohort mean ± SD age was 55 ± 15 years old and included 52% women, 24% African-Americans and 48% diabetics. Compared with patients with serum Cr levels of 8.0-9.9 mg/dL, patients with serum Cr levels of <4.0 mg/dL and 4.0-5.9 mg/dL had higher risks of death {HR 1.36 [95% confidence interval (95% CI) 1.19-1.55] and 1.19 (1.08-1.31), respectively} whereas patients with serum Cr levels of 10.0-11.9 mg/dL, 12.0-13.9 mg/dL and ≥14.0 mg/dL had lower risks of death (HR 0.88 [95% CI 0.79-0.97], 0.71 [0.62-0.81] and 0.64 [0.55-0.75], respectively) in the fully adjusted model. Decrease in serum Cr level over 1.0 mg/dL during the 3 months predicted an increased risk of death additionally. The serum Cr-mortality association was robust in patients with PD treatment duration of ≥12 months, but was not observed in those with PD duration of <3 months.

Conclusions: Muscle mass reflected in serum Cr level may be associated with survival even in PD patients. However, the serum Cr-mortality association is attenuated in the early period of PD treatment, suggesting competing effect of muscle mass versus residual renal function on mortality.