Constipation and Clinical Outcomes in Peritoneal Dialysis: Results from Thailand PDOPPS
Bibliographic record
Abstract
Background: Patient-reported outcome measures (PROM) has gained international recognition as important predictors of clinical outcomes in peritoneal dialysis (PD). We sought to understand the associations between patient-reported constipation and clinical outcomes. Methods: Constipation was determined in patients across 22 facilities in Thailand Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) during 2014-2017. Constipation was diagnosed using both objective assessment tools (Bristol Stool Form Scale [BSFS]) and self-reported questionnaire, constipation severity score [CSS]). BSFS is a 7-level scale visual inspection of feces (from 1 to 7, from hard to softer) based on its texture and morphology. Whilst the CSS measures duration (1 item) and severity (7 items: frequency of bowel movement, difficulty, pain, completeness, attempt duration, defecation assistance, frequency of attempt failure) of constipation and is a self-filled questionnaire, with participants being asked to respond on a 5-point Likert scale coded. Cox proportional hazards model regression was used to estimate associations between constipation and clinical outcomes, including mortality, hemodialysis (HD) transfer and peritonitis. Results: 634 of 975 randomly selected PD patients from 22 facilities reported their constipation by using BSFS and CSS. In this questionnaire, the patients rated their constipation as well as a change in constipation over time. Constipation was common in the PD population, particularly in patients with older age, marriage, diabetes, lower educational level, and worse nutritional status (including lower time-average serum albumin and phosphate concentrations). Interestingly, self-reported constipation at baseline was significantly associated with shorter time to first and higher rates of peritonitis (hazard ratio [HR] 1.74, 95%CI 1.29-2.34) and death (HR 2.43, 95%CI 1.82-3.24) but not HD transfer (HR 1.25, 95%CI 0.7-2.21) after adjusting for age, gender, PD vintage, comorbidities, shared frailty by study sites, and serum albumin. Conclusions: Patient-reported constipation was independently associated with higher risks of peritonitis and all-cause mortality, but not HD transfer. This warrants further investigation to identify effective interventions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".