The impact of serum myokine profile on the outcome of peritoneal dialysis patients

BACKGROUND: Peritoneal dialysis (PD) patients are at high risk for complications such as muscle loss and peritonitis. Individual myokines and functional assessment of PD patients are inconsistently reported to associate with poor prognosis, but their complex interactions for risk stratification have not been studied. METHODS: In 194 new PD patients, we measured the serum levels of a myokine panel, metabolic and inflammatory markers, together with physical function scores. We employed k-cluster analysis on the result and analyzed patient survival, technique survival, peritonitis-free survival, hospitalisation rate and duration between the patient clusters. RESULTS: There are two distinct patient clusters; cluster 1 showed a higher risk profile, with higher Morse Fall Scores, lower Norton scores, lower lean tissue mass, and different myokine levels. Cluster 2 is independently associated with better patient survival (adjusted hazard ratio 0.460, 95% confidence interval [CI] 0.237 to 0.894, p = 0.022) and peritonitis-free survival rate (AHR 0.417, 95% CI 0.205 to 0.846, p = 0.015). Cluster 2 also had lower hospitalisation rate (p = 0.022) and shorter duration of hospital stay (p = 0.014). Individual parameters used for the cluster analysis, however, were not independent predictors. CONCLUSION: A combined assessment of myokine profile and functional status of new PD patients is independently associated with patient survival, peritonitis-free survival, and hospitalization rates. Our results underscore the importance of a comprehensive, integrated approach to patient assessment, which can improve the risk stratification for this vulnerable population.