Creatine Kinase and Mortality in Peritoneal Dialysis

Xianfeng Wu; Lei Zhou; Xiaojiang Zhan; Yueqiang Wen; Xiaoyang Wang; Xiaoran Feng; Niansong Wang; Fenfen Peng; Junnan Wu

doi:10.3389/fcvm.2022.855891

Creatine Kinase and Mortality in Peritoneal Dialysis

Front Cardiovasc Med. 2022 May 10:9:855891. doi: 10.3389/fcvm.2022.855891. eCollection 2022.

Authors

Xianfeng Wu^{1

2}, Lei Zhou³, Xiaojiang Zhan⁴, Yueqiang Wen⁵, Xiaoyang Wang⁶, Xiaoran Feng⁷, Niansong Wang^{1

2}, Fenfen Peng⁸, Junnan Wu³

Affiliations

¹ Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
² Clinical Research Center for Chronic Kidney Disease, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
³ Department of Nephrology, Zhejiang University Medical College Affiliated Sir Run Run Shaw Hospital, Hangzhou, China.
⁴ Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, China.
⁵ Department of Nephrology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
⁶ Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
⁷ Department of Nephrology, Jiujiang No.1 People's Hospital, Jiujiang, China.
⁸ Department of Nephrology, Zhujiang Hospital of Southern Medical University, Guangzhou, China.

Abstract

Background: The association between serum creatine kinase and mortality in patients with peritoneal dialysis (PD) remained unknown.

Methods: We retrospectively collected data on 3,446 incident patients with from five PD centers in China between 1 January 2005 and 31 May 2020. Creatine kinase was collected 1 week before the start of PD. We examined the association between creatine kinase and mortality using Cox proportional hazards model.

Results: The median creatine kinase was 113 (range, 1.22-4,574) IU/L. With a median follow-up of 39.5 (range, 3.1-181.5) months, 763 (22.1%) all-cause deaths occurred, including 384 (11.1%) cardiovascular deaths. As compared with a creatine kinase of 111-179 IU/L (reference range), a higher creatine kinase (>179 IU/L) was associated with increased risks of all-cause mortality [hazards ratio (HR), 1.72; 95% CI, 1.35-2.00; E-value = 2.83] and cardiovascular mortality (HR, 1.44; 95% CI, 1.05-1.98; E-value = 2.24). As compared with the reference range, a lower creatine kinase (<111 IU/L) was associated with increased risks of all-cause mortality (HR, 1.40; 95% CI, 1.12-1.76; E-value = 2.15) and cardiovascular mortality (HR, 1.45; 95% CI, 1.08-1.94; E-value = 2.26). Interaction between creatine kinase and no hyperlipidemia (p = 0.034 for interaction) was observed.

Conclusion: A creatine kinase before the start of PD between 111 and 179 IU/L was associated with a lower risk of death than a higher or lower creatine kinase, resulting in a U-shaped association curve.

Keywords: cardiovascular mortality; creatine kinase; mortality; peritoneal dialysis; prognosis.