Association of Serum Chloride Concentration With All-Cause and Cardiovascular Mortality in Patients Undergoing Peritoneal Dialysis: The Fukuoka Peritoneal Dialysis Registry.

Authors

Tomoya Hamashoji, Shoji Tsuneyoshi, Kazuhiro Okamura, Shunsuke Yamada, Kazuhiko Tsuruya, Toshiaki Nakano, Tetsuro Ago, Fukuoka Peritoneal Dialysis Registry (F-PDR) group

Published in

Kidney medicine. Volume 8. Issue 8. Pages 101441. Epub Jun 16, 2026.

Abstract

Low serum chloride concentration is linked to mortality in chronic kidney disease and hemodialysis, but evidence in peritoneal dialysis (PD) has largely come from incident cohorts. We evaluated whether serum chloride concentration at registry enrollment is independently associated with all-cause and cardiovascular mortality among maintenance PD patients.
Multicenter retrospective cohort study.
The Fukuoka Peritoneal Dialysis Registry (F-PDR) enrolled PD patients from 20 centers in Japan (2011-2020). Enrollment in this cohort study was not restricted to the time of PD initiation. After excluding patients with PD duration <90 days at F-PDR enrollment, 1,049 maintenance PD patients were analyzed.
Serum chloride concentration at registry enrollment, categorized into tertiles (T1 <96, T2 96-99, and T3 >99 mmol/L).
All-cause mortality (primary) and cardiovascular mortality (secondary).
Cox proportional hazards models estimated HR and 95% CI with multivariable adjustment including serum sodium and other prespecified covariates. Missing covariates were handled with multiple imputation.
Over a median follow-up of 731 days, 179 patients (17.1%) died, including 59 (5.6%) from cardiovascular causes. In the fully adjusted model, compared with T3 (>99 mmol/L), T1 (<96 mmol/L) was associated with higher risks of all-cause mortality (HR, 2.59; 95% CI, 1.55-4.34) and cardiovascular mortality (HR, 3.33; 95% CI, 1.28-8.66).
Observational design with potential residual confounding. Serum chloride and covariates were measured only at registry enrollment. Serum bicarbonate was unavailable. Generalizability may be limited.
In maintenance PD patients, lower serum chloride concentration was independently associated with increased all-cause and cardiovascular mortality risks, suggesting serum chloride may be a useful marker for risk assessment.

PMID:
42534448
Bibliographic data and abstract were imported from PubMed on 31 Jul 2026.

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