{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T06:12:14Z","timestamp":1788415934754,"version":"build-2803163510"},"reference-count":59,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nephrol."],"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>This study developed and validated a robust, clinically applicable risk prediction model for cardiovascular mortality in high-risk peritoneal dialysis patients. The model enables precise individualized risk stratification, supports evidence-based clinical decisions, and facilitates targeted preventive interventions to improve long-term outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis was conducted on peritoneal dialysis patients at the Department of Nephrology, First Affiliated Hospital of Xi\u2019an Jiaotong University, from June 2018 to May 2025. Cardiovascular disease served as the primary endpoint. Baseline characteristics and laboratory parameters were compared between groups. Univariate and multivariate regression analyses identified predictors of major adverse cardiovascular events. The predictive model was developed and validated using a 7:3 split after bootstrap resampling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Multivariate analysis identified age, fasting blood glucose, absolute handgrip strength, and left ventricular ejection fraction as significant predictors. ROC curves (AUC &amp;gt; 0.6) and Kaplan\u2013Meier curves (P &amp;lt; 0.05) confirmed their diagnostic and discriminatory value for major adverse cardiovascular events. A nomogram incorporating these four variables was developed. Its AUCs for predicting 3-, 5-, and 8-year cardiovascular event incidence were 0.828 (95% CI: 0.744\u20130.912), 0.785 (95% CI: 0.702\u20130.868), and 0.836 (95% CI: 0.744\u20130.929), respectively\u2014indicating strong predictive discrimination. Using the optimal cut-off, patients were stratified into low- and high-risk groups. Kaplan\u2013Meier analysis showed significant differences in cumulative event incidence at all three time points (P &amp;lt; 0.001), confirming good discrimination. Calibration demonstrated close agreement between predicted and observed outcomes; decision curve analysis supported robust clinical utility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Age, fasting blood glucose, absolute handgrip strength, and left ventricular ejection fraction are independent predictors of MACE in patients receiving PD. We have developed and internally validated a novel, interpretable nomogram-based risk prediction model that demonstrates high discriminative accuracy, calibration fidelity, and clinical utility. This tool holds substantial promise for early identification of high-risk individuals at PD initiation, thereby facilitating timely, personalized cardiovascular risk mitigation strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneph.2026.1871318","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:13:35Z","timestamp":1788412415000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Construction and evaluation of risk prediction model for major adverse cardiovascular events in peritoneal dialysis patients"],"prefix":"10.3389","volume":"6","author":[{"given":"Jing","family":"Han","sequence":"first","affiliation":[{"name":"Department of Nephrology, Xi\u2019an No.3 Hospital, The Affiliated Hospital of Northwest University","place":["Xi\u2019an, Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoli","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Xi\u2019an No.3 Hospital, The Affiliated Hospital of Northwest University","place":["Xi\u2019an, Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuejiao","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Xi\u2019an No.3 Hospital, The Affiliated Hospital of Northwest University","place":["Xi\u2019an, Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiping","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The First Affiliated Hospital of Medical College, Xi\u2019an Jiaotong University","place":["Xi\u2019an, Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Shaanxi Provincial People\u2019s Hospital","place":["Xi\u2019an, Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Xi\u2019an No.3 Hospital, The Affiliated Hospital of Northwest University","place":["Xi\u2019an, Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.cd013800","article-title":"Peritoneal dialysis versus haemodialysis for people commencing dialysis","volume":"6","author":"Ethier","year":"2024","journal-title":"Cochrane Database Syst Rev"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1681\/asn.2016010112","article-title":"The current state of peritoneal dialysis","volume":"27","author":"Mehrotra","year":"2016","journal-title":"Am Soc Nephrol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"A8","DOI":"10.1053\/j.ajkd.2022.02.001","article-title":"US Renal Data System 2021 Annual Data Report: Epidemiology of kidney disease in the United States","volume":"79","author":"Johansen","year":"2022","journal-title":"Am J Kidney Dis"},{"key":"B4","doi-asserted-by":"publisher","first-page":"A6","DOI":"10.1053\/j.ajkd.2019.09.003","article-title":"US Renal Data System 2019 Annual Data Report: Epidemiology of kidney disease in the United States","volume":"75","author":"Saran","year":"2020","journal-title":"Am J Kidney Dis"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1097\/md.0000000000024616","article-title":"The occurrence and potential predictive factors of major adverse cardiac and cerebral events in end-stage renal disease patients on continuous ambulatory peritoneal dialysis: A prospective cohort study","volume":"100","author":"Yao","year":"2021","journal-title":"Med (Baltimore)"},{"key":"B6","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1186\/s12882-023-03187-1","article-title":"Total cholesterol and mortality in peritoneal dialysis: a retrospective cohort study","volume":"24","author":"Wu","year":"2023","journal-title":"BMC Nephrol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvae124","article-title":"Cardiac ageing: from hallmarks to therapeutic opportunities","volume":"121","author":"Hastings","year":"2025","journal-title":"Cardiovasc Res"},{"key":"B8","doi-asserted-by":"publisher","first-page":"395","DOI":"10.3390\/cells10020395","article-title":"Role of telomeres shortening in atherogenesis: An overview","volume":"10","author":"Yegorov","year":"2021","journal-title":"Cells"},{"key":"B9","doi-asserted-by":"publisher","first-page":"33527","DOI":"10.1038\/s41598-025-18015-9","article-title":"Risk factors for cardiovascular death in urgent-start peritoneal dialysis patients: a multicenter retrospective cohort study","volume":"15","author":"Meng","year":"2025","journal-title":"Sci Rep"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.2741\/3064","article-title":"Oxidative stress in vascular senescence: lessons from successfully aging species","volume":"13","author":"Ungvari","year":"2008","journal-title":"Front Biosci"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3390\/nu13113688","article-title":"Utility of geriatric nutritional risk index in patients with chronic kidney disease: A mini-review","volume":"13","author":"Nakagawa","year":"2021","journal-title":"Nutrients"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.2009.28160","article-title":"Energy intake and expenditure profile in chronic peritoneal dialysis patients complicated with circulatory congestion","volume":"90","author":"Wang","year":"2009","journal-title":"Am J Clin Nutr"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1053\/j.jrn.2018.08.006","article-title":"Global prevalence of protein-energy wasting in kidney disease: A meta-analysis of contemporary observational studies from the International Society of Renal Nutrition and Metabolism","volume":"28","author":"Carrero","year":"2018","journal-title":"J Ren Nutr"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.01.061","article-title":"Body fat distribution and incident cardiovascular disease in obese adults","volume":"65","author":"Neeland","year":"2015","journal-title":"J Am Coll Cardiol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.freeradbiomed.2015.12.031","article-title":"The role of E3 ubiquitin-ligases MuRF-1 and MAFbx in loss of skeletal muscle mass","volume":"98","author":"Rom","year":"2016","journal-title":"Free Radic Biol Med"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jshs.2023.04.001","article-title":"Skeletal muscle atrophy, regeneration, and dysfunction in heart failure: Impact of exercise training","volume":"12","author":"Gallagher","year":"2023","journal-title":"J Sport Health Sci"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2013.02.001","article-title":"Muscle strength rather than muscle mass is associated with standing balance in elderly outpatients","volume":"14","author":"Bijlsma","year":"2013","journal-title":"J Am Med Dir Assoc"},{"key":"B18","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1186\/s12986-020-00506-3","article-title":"The cut-off values of handgrip strength and lean mass index for sarcopenia among patients on peritoneal dialysis","volume":"17","author":"Xu","year":"2020","journal-title":"Nutr Metab (Lond)"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1530\/endoabs.90.oc1.4","article-title":"Associations between handgrip strength and skeletal muscle mass with all-cause mortality and cardiovascular mortality in people with type 2 diabetes: A prospective cohort study of the UK Biobank","volume":"16","author":"Wei","year":"2024","journal-title":"J Diabetes"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2020.00719","article-title":"The relative handgrip strength and risk of cardiometabolic disorders: A prospective study","volume":"11","author":"Hao","year":"2020","journal-title":"Front Physiol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1046\/j.1532-5415.2003.51105.x","article-title":"Strength and muscle quality in a well-functioning cohort of older adults: the Health, Aging and Body Composition Study","volume":"51","author":"Newman","year":"2003","journal-title":"J Am Geriatr Soc"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0056483","article-title":"Body mass index, muscle strength and physical performance in older adults from eight cohort studies: the HALCyon programme","volume":"8","author":"Hardy","year":"2013","journal-title":"PloS One"},{"key":"B23","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s12603-014-0492-6","article-title":"Cross-sectional associations between different measures of obesity and muscle strength in men and women in a British cohort study","volume":"19","author":"Keevil","year":"2015","journal-title":"J Nutr Health Aging"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.5812\/ijem.61201","article-title":"Metabolic syndrome increases mortality risk in dialysis patients: A systematic review and meta-analysis","volume":"16","author":"Sanguankeo","year":"2018","journal-title":"Int J Endocrinol Metab"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/j.dsx.2019.02.023","article-title":"Insulin resistance is a cardiovascular risk factor in humans","volume":"13","author":"Adeva-Andany","year":"2019","journal-title":"Diabetes Metab Syndr"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1159\/000500979","article-title":"Triglyceride glucose index predicting cardiovascular mortality in Chinese initiating peritoneal dialysis: A cohort study","volume":"44","author":"Yan","year":"2019","journal-title":"Kidney Blood Press Res"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1681\/asn.20223311s1449d","article-title":"Fasting blood glucose level and risk of all-cause and cause-specific mortality in peritoneal dialysis patients","volume":"16","author":"Lim","year":"2024","journal-title":"Diabetes"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.3892\/etm.2017.5584","article-title":"Insulin resistance, blood glucose and inflammatory cytokine levels are risk factors for cardiovascular events in diabetic patients complicated with coronary heart disease","volume":"15","author":"Wang","year":"2018","journal-title":"Exp Ther Med"},{"key":"B29","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1186\/s12882-016-0336-1","article-title":"Blood pressure and proteinuria control remains a challenge in patients with type 2 diabetes mellitus and chronic kidney disease: experience from the prospective observational ALICE-PROTECT study","volume":"17","author":"Halimi","year":"2016","journal-title":"BMC Nephrol"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20116736(10)60484\u20119","article-title":"Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies","volume":"375","author":"Sarwar","year":"2010","journal-title":"Lancet"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.5414\/cn110979","article-title":"Relationship of serum albumin at initiation of incident peritoneal dialysis with cardiovascular and overall survival","volume":"99","author":"Pitanupong","year":"2023","journal-title":"Clin Nephrol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"17948","DOI":"10.1038\/s41598-017-17965-z","article-title":"Estimated glomerular filtration rate, proteinuria, and risk of cardiovascular diseases and all-cause mortality in diabetic population: a community-based cohort study","volume":"7","author":"Wang","year":"2017","journal-title":"Sci Rep"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.14019","article-title":"Higher BNP\/NT-pro BNP levels stratify prognosis equally well in patients with and without heart failure: a meta-analysis","volume":"9","author":"Hendricks","year":"2022","journal-title":"ESC Heart Fail"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2016.06.006","article-title":"The relationship of plasma NT-proBNP to age and outcomes in heart failure","volume":"4","author":"Richards","year":"2016","journal-title":"JACC Heart Fail"},{"key":"B35","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1186\/s43044-023-00401-1","article-title":"Effect of body mass index on N-terminal pro-brain natriuretic peptide values in patients with heart failure","volume":"75","author":"Ha Manh","year":"2023","journal-title":"Egypt Heart J"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1209","article-title":"Sex-specific associations of obesity and N-terminal pro-B-type natriuretic peptide levels in the general population","volume":"20","author":"Suthahar","year":"2018","journal-title":"Eur J Heart Fail"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1210\/endrev\/bnac029","article-title":"A state of natriuretic peptide deficiency","volume":"44","author":"Nyberg","year":"2023","journal-title":"Endocr Rev"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1771","article-title":"Sex-related differences in contemporary biomarkers for heart failure: a review","volume":"22","author":"Suthahar","year":"2020","journal-title":"Eur J Heart Fail"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.14203","article-title":"Association between hypomagnesemia and mortality among dialysis patients: a systematic review and meta-analysis","volume":"10","author":"Huang","year":"2022","journal-title":"PeerJ"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.3390\/cells14161280","article-title":"The Yin and Yang of heartbeats: Magnesium-calcium antagonism is essential for cardiac excitation-contraction coupling","volume":"14","author":"Marabelli","year":"2025","journal-title":"Cells"},{"key":"B41","doi-asserted-by":"publisher","first-page":"1714","DOI":"10.3390\/nu14091714","article-title":"The role of magnesium in the pathogenesis of metabolic disorders","volume":"14","author":"Pelczy\u0144ska","year":"2022","journal-title":"Nutrients"},{"key":"B42","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1186\/s12882-017-0549-y","article-title":"Lower serum magnesium is associated with vascular calcification in peritoneal dialysis patients: a cross sectional study","volume":"18","author":"Molnar","year":"2017","journal-title":"BMC Nephrol"},{"key":"B43","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.xkme.2020.10.010","article-title":"Serum magnesium and cardiovascular outcomes and mortality in CKD: The Chronic Renal Insufficiency Cohort (CRIC)","volume":"3","author":"Negrea","year":"2021","journal-title":"Kidney Med"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.3390\/nu15245127","article-title":"The integral role of magnesium in muscle integrity and aging: A comprehensive review","volume":"15","author":"Souza","year":"2023","journal-title":"Nutrients"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.3390\/antiox9100907","article-title":"Magnesium, oxidative stress, inflammation, and cardiovascular disease","volume":"9","author":"Liu","year":"2020","journal-title":"Antioxidants (Basel)"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.2215\/cjn.01870217","article-title":"Cholecalciferol, calcitriol, and vascular function in CKD: A randomized, double-blind trial","volume":"12","author":"Kendrick","year":"2017","journal-title":"Clin J Am Soc Nephrol"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2013.02.014","article-title":"Parathyroid hormone and cardiovascular disease events: A systematic review and meta-analysis of prospective studies","volume":"165","author":"van Ballegooijen","year":"2013","journal-title":"Am Heart J"},{"key":"B48","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1016\/j.ahj.2014.04.017","article-title":"Parathyroid hormone concentration and risk of cardiovascular diseases: the Atherosclerosis Risk in Communities (ARIC) study","volume":"168","author":"Folsom","year":"2014","journal-title":"Am Heart J"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1007\/s12471-014-0577-1","article-title":"Assessment of LV ejection fraction using real-time 3D echocardiography in daily practice: direct comparison of the volumetric and speckle tracking methodologies to CMR","volume":"22","author":"Driessen","year":"2014","journal-title":"Neth Heart J"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1097\/md.0000000000000819","article-title":"Left ventricular diastolic dysfunction in peritoneal dialysis: a forgotten risk factor","volume":"94","author":"Wu","year":"2015","journal-title":"Med (Baltimore)"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1111\/nep.13154","article-title":"Association of left ventricular systolic dysfunction with mortality in incident peritoneal dialysis patients","volume":"23","author":"Wang","year":"2018","journal-title":"Nephrol (Carlton)"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2012.12.030","article-title":"Heart failure with preserved or reduced ejection fraction in patients treated with peritoneal dialysis","volume":"61","author":"Wang","year":"2013","journal-title":"Am J Kidney Dis"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1077","article-title":"Prevalence of left ventricular systolic dysfunction in pre-dialysis and dialysis patients with preserved left ventricular ejection fraction","volume":"20","author":"Hensen","year":"2018","journal-title":"Eur J Heart Fail"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1007\/s10554-016-1059-x","article-title":"Subclinical markers of cardiovascular disease predict adverse outcomes in chronic kidney disease patients with normal left ventricular ejection fraction","volume":"33","author":"Sulemane","year":"2017","journal-title":"Int J Cardiovasc Imaging"},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.21542\/gcsp.2022.11","article-title":"The overestimation of concentric hypertrophy in patients with HFpEF as determined by 2D-echocardiography","volume":"2022","author":"Mathbout","year":"2022","journal-title":"Glob Cardiol Sci Pract"},{"key":"B56","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1159\/000316682","article-title":"Malnutrition-inflammation score independently determined cardiovascular and infection risk in peritoneal dialysis patients","volume":"30","author":"Ho","year":"2010","journal-title":"Blood Purif"},{"key":"B57","doi-asserted-by":"publisher","DOI":"10.3747\/pdi.2014.00124","article-title":"Coronary artery calcification score as a predictor of all-cause mortality and cardiovascular outcome in peritoneal dialysis patients","volume":"36","author":"Xie","year":"2016","journal-title":"Perit Dial Int"},{"key":"B58","doi-asserted-by":"publisher","DOI":"10.1111\/nep.12094","article-title":"Performance of the Framingham risk score in patients receiving hemodialysis","volume":"18","author":"Huang","year":"2013","journal-title":"Nephrol (Carlton)"},{"key":"B59","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0060008","article-title":"Framingham risk score with cardiovascular events in chronic kidney disease","volume":"8","author":"Chen","year":"2013","journal-title":"PloS One"}],"container-title":["Frontiers in Nephrology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneph.2026.1871318\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:13:36Z","timestamp":1788412416000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneph.2026.1871318\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":59,"alternative-id":["10.3389\/fneph.2026.1871318"],"URL":"https:\/\/doi.org\/10.3389\/fneph.2026.1871318","relation":{},"ISSN":["2813-0626"],"issn-type":[{"value":"2813-0626","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]},"article-number":"1871318"}}