Modesto Ana Paula, Usvyat Len, Calice-Silva Viviane, Spigolon Dandara Novakowski, Figueiredo Ana Elizabeth, de Moraes Thyago Proença, Olandoski Marcia, Shimakura Silvia Emiko, Barreti Pasqual, Kotanko Peter, Pecoits-Filho Roberto
Pontifícia Universidade Católica do Paraná (PUCPR), School of Medicine, Curitiba, Brazil.
Renal Research Institute, New York, NY, USA.
Perit Dial Int. 2018 Jan-Feb;38(1):24-29. doi: 10.3747/pdi.2015.00241. Epub 2017 Aug 1.
Simple and low-cost tools to monitor the risk profile of patients on peritoneal dialysis (PD) at high risk of complications and mortality are scarce. One of the tools available to monitor the variation in vitality and dependence levels is the Karnofsky performance status (KPS). This study analyzed the average trends and variation of KPS during the 12 months before death and its independent value in predicting patients' survival.
The data were compiled from the BRAZPD II multicenter study, performed in Brazil between 2004 and 2011. For the analysis of KPS dynamics, we included patients with at least 12 months of follow-up on PD and who had a fatal event during the follow-up. The following covariables were evaluated: age, gender, ethnicity, educational level, and presence of diabetes. We used the linear regression model to present the results: the log (time) before death was represented by the regression variable and KPS was the response. We also analyzed the independent impact of baseline KPS on patients' survival.
From the population of 9,905 patients enrolled in the BRAZPD study, 4,133 survived 12 months on PD and were included in the analysis. There was a gradual decline in the KPS scores, which accelerated in the last 2 months before death. These changes were similar irrespective of age, race, family income, gender, diabetes, PD modality, and education level. We observed 989 fatal events in this population during the observation period, and the KPS score was identified as an independent predictor for mortality in this cohort.
This study demonstrates for the first time the dynamics of KPS before death in PD patients, indicating a progressive and accelerated decline of KPS in the 12 months before patients died. In addition, KPS was an independent predictor of mortality in this population.
用于监测腹膜透析（PD）患者并发症和死亡高风险的简单且低成本工具稀缺。可用于监测活力和依赖水平变化的工具之一是卡诺夫斯基功能状态（KPS）。本研究分析了死亡前12个月内KPS的平均趋势和变化及其在预测患者生存方面的独立价值。
数据来自2004年至2011年在巴西进行的BRAZPD II多中心研究。为分析KPS动态，我们纳入了至少接受12个月PD随访且在随访期间发生致命事件的患者。评估了以下协变量：年龄、性别、种族、教育水平和糖尿病的存在情况。我们使用线性回归模型呈现结果：死亡前的对数（时间）由回归变量表示，KPS为反应变量。我们还分析了基线KPS对患者生存的独立影响。
在BRAZPD研究纳入的9905名患者中，4133名患者PD存活12个月并纳入分析。KPS评分逐渐下降，在死亡前最后2个月加速下降。无论年龄、种族、家庭收入、性别、糖尿病、PD方式和教育水平如何，这些变化都是相似的。在观察期内，我们在该人群中观察到989例致命事件，KPS评分被确定为该队列中死亡率的独立预测因素。
本研究首次展示了PD患者死亡前KPS的动态变化，表明患者死亡前12个月KPS呈渐进性加速下降。此外，KPS是该人群死亡率的独立预测因素。
