Outcomes of patients with Cholesterol crystal embolism treated by peritoneal dialysis: retrospective study from the RDPLF registry.
DOI:
https://doi.org/10.25796/bdd.v5i1.65303Keywords:
peritoneal dialysis, survival, outcome, cholesterol crystal embolism, renal failureAbstract
Cholesterol crystal embolisms disease (CED) is a systemic disease characterized by tissue ischemia and microinflammation related to occlusion of arterioles by microemboli from ulcerated atheromatous plaques. The kidney is one of the most affected organs, often requiring dialysis. Our study examines the outcomes of a cohort of patients with CED treated with peritoneal dialysis (PD). As anticoagulants can favor emboli, peritoneal dialysis may theoretically have an advantage.
From the database of the French Language Peritoneal Dialysis Registry (RDPLF), between January 1, 1995, and December 31, 2021, we selected patients treated with PD for >90 days and with an age >18 years. On the basis of the variables of patient autonomy, diabetes, BMI, modified Charlson index, age, sex, pre-PD treatment, causes of death, causes of transfer to hemodialysis, and peritonitis, three types of survival were estimated (patient, technical, and composite). After adjustment by propensity scores and taking into account competitive risks, 2 groups of patients were constituted on the basis of baseline nephropathy: emboli group vs. control group.
Patient survival and strict technical survival are not associated with the type of nephropathy (CED versus others). Composite technical survival (uncensored for deaths and transfers to hemodialysis) was only associated with cholesterol emboli nephropathy in the multivariate analysis adjusted for diabetes, autonomy, and age of the patient at the start of the dialysis treatment (p=0.011; 95% CI [0.736 [0.581-0.931]]).
Our study from the RDPLF database shows no difference in technical and patient survival in a cohort of patients with CED vs. a control group. It also confirms that PD may represent an adequate choice in this pathology.
References
Mulay SR, Anders HJ. Crystallopathies. N Engl J Med. 2016;374(25):2465-2476. DOI: https://doi.org/10.1056/NEJMra1601611
Mulay SR, Anders HJ. Crystal nephropathies: mechanisms of crystal-induced kidney injury. Nat Rev Nephrol. 2017;13(4):226-240 DOI: https://doi.org/10.1038/nrneph.2017.10
Shi C, Kim T, Steiger S, et al. Crystal Clots as Therapeutic Target in Cholesterol Crystal Embolism. Circ Res. 2020;126(8):e37-e52. DOI: https://doi.org/10.1161/CIRCRESAHA.119.315625
Ozkok A. Cholesterol-embolization syndrome: current perspectives. Vasc Health Risk Manag. 2019;15:209-220. DOI: https://doi.org/10.2147/VHRM.S175150
Denis Le Seve J, Gourraud Vercel C, Connault J, Artifoni M. État des lieux de la maladie des emboles de cholestérol [Update on cholesterol crystal embolism]. Rev Med Interne. 2020;41(4):250-257. DOI: https://doi.org/10.1016/j.revmed.2020.02.002
Tanaka H, Yamana H, Matsui H, Fushimi K, Yasunaga H. Proportion and risk factors of cholesterol crystal embolization after cardiovascular procedures: a retrospective national database study. Heart Vessels. 2020;35(9):1250-1255. DOI: https://doi.org/10.1007/s00380-020-01593-1
Scolari F, Tardanico R, Zani R, et al. Cholesterol crystal embolism: A recognizable cause of renal disease. Am J Kidney Dis. 2000;36(6):1089-1109 DOI: https://doi.org/10.1053/ajkd.2000.19809
Meyrier A. Cholesterol crystal embolism: diagnosis and treatment. Kidney Int. 2006;69(8):1308-1312. DOI: https://doi.org/10.1038/sj.ki.5000263
Scolari F, Ravani P, Gaggi R, et al. The challenge of diagnosing atheroembolic renal disease: clinical features and prognostic factors. Circulation. 2007;116(3):298-304. DOI: https://doi.org/10.1161/CIRCULATIONAHA.106.680991
Scolari F, Ravani P. Atheroembolic renal disease. Lancet. 2010;375(9726):1650-1660. DOI: https://doi.org/10.1016/S0140-6736(09)62073-0
Li X, Bayliss G, Zhuang S. Cholesterol Crystal Embolism and Chronic Kidney Disease. Int J Mol Sci. 2017;18(6):1120. DOI: https://doi.org/10.3390/ijms18061120
Piccoli GB, Fenoglio R, Colla L, et al. Cholesterol crystal embolism syndrome in dialysis patients: an emerging clinical diagnosis?. Blood Purif. 2006;24(5-6):433-438. DOI: https://doi.org/10.1159/000095359
Matsui K, Mochida Y, Ishioka K, et al. A case of enteric peritonitis in a patient with stage 5 kidney disease due to cholesterol crystal embolization. Perit Dial Int. 2020;40(2):220-221 DOI: https://doi.org/10.1177/0896860819887293
González AP, Juega J, Vazquez C, et al. Late Onset of Cholesterol Embolism Leading to Graft Failure After Renal Transplantation: Report of Two Cases. Transplant Proc. 2015;47(8):2361-2363. DOI: https://doi.org/10.1016/j.transproceed.2015.09.005
Verger C, Ryckelynck JP, Duman M, Veniez G, Lobbedez T, Boulanger E, Moranne O. French peritoneal dialysis registry (RDPLF): outline and main results. Kidney Int Suppl. 2006 Nov;(103):S12-20. doi: 10.1038/sj.ki.5001911. Erratum in: Kidney Int Suppl. 2007 Jan;71(1):87. Fabre, E [added]. DOI: https://doi.org/10.1038/sj.ki.5002051
Verger C, Fabre E, Veniez G, Padernoz MC. Synthetic 2018 data report of the French Language Peritoneal Dialysis and Home Hemodialysis Registry (RDPLF). Bull Dial Domic [Internet]. 2019Apr.10 [cited 2022Feb.25];2(1):1-10. Available from: https://doi.org/10.25796/bdd.v2i1.19093 DOI: https://doi.org/10.25796/bdd.v2i1.19093
White IR, Royston P, Wood AM. Multiple imputation using chained equations: Issues and guidance for practice. Stat Med 2011;30). 377-399 DOI: https://doi.org/10.1002/sim.4067
Schemper M, Smith TL. A note on quantifying follow-up in studies of failure time. Control Clin Trials. 1996 Aug;17(4):343-6 DOI: https://doi.org/10.1016/0197-2456(96)00075-X
. Fine J and Gray R-J. A Proportional Hazards Model for the Subdistribution of a Competing Risk, Journal of the American Statistical Association, Vol. 94, No. 446 (Jun., 1999), pp. 496-509 DOI: https://doi.org/10.1080/01621459.1999.10474144
Gillerot G, Sempoux C, Pirson Y, Devuyst O. Which type of dialysis in patients with cholesterol crystal embolism?. Nephrol Dial Transplant. 2002;17(1):156-158. DOI: https://doi.org/10.1093/ndt/17.1.156
Ravani P, Gaggi R, Rollino C, et al. Lack of association between dialysis modality and outcomes in atheroembolic renal disease. Clin J Am Soc Nephrol. 2010;5(3):454-459. DOI: https://doi.org/10.2215/CJN.06590909
Indications et non-indications de la dialyse péritonéale chronique chez l’adulte RECOMMANDATION DE BONNE PRATIQUE - Octobre 2008 HAS. [Internet, cited 2022Feb.25]; available from
https://www.has-sante.fr/jcms/c_702938/fr/dialyse-peritoneale-chronique-chez-l-adulte-argumentaire
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Angelo Testa, Emmanuel Chamorey, Frederic Lavainne, Christian Verger
This work is licensed under a Creative Commons Attribution 4.0 International License.
