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Background and Aims
in Italy only a minority of uremic patients perform peritoneal dialysis (PD). In dialysis centers where PD is practiced and proposed the prevalence is no more than 23%. Proposed advantages of PD over HD are a more preserved Residual renal function (RRF), that has been associated with better survival, and better Quality of life (Qol) due to possible more preservation of previous lifestyle, independence, possibility of traveling, and flexibility. Incremental peritoneal dialysis is a promising way to further improve Qol and to preserve RRF. Lastly, PD is less expensive than HD. Aim of this study has been to retrospectively evaluate our ten-years experience of PD treatment on survival, dialysis adequacy, preservation of RRF and nutrition in uremic patients followed at our Dialysis Center.
Method
We retrospectively evaluated all the incident patients that started PD treatment due to uremia from 01-01-2008 to 31-12-2018 at the U.O. Nephrology ASST Spedali Civili of Brescia. The exclusion criteria were time of dialysis treatment less than 3 months and absence of previous dialytic treatment or kidney transplantation. For each patient anthropometric, clinical-anamnestic data and comorbidities at dialysis start were recorded.
Data on dialysis adequacy, nutrition, RRF and PD dialysis modality performed were also recorded.
Results
During the observation period 329 patients started PD. 60 were excluded due to follow-up of less than 3 months. Therefore, 269 patients (males 160, 59%) were studied. The average age was 65±16 years, BMI 24±4 kg/m2. Comorbidities were: hypertension (87%), diabetes mellitus (32%), cerebral vascular disease (26%) and ischemic heart disease (25%). The mean duration of dialysis treatment was 2.1±1.5 years. At the end of ten-years follow-up 24% of patients have had a kidney transplant, 18% were on PD treatment, 17% have had a shift towards HD, 39% had died. The main causes of death were: infection (39%) and cardiovascular disease (31%). The most common dialysis modality performed was APD (61%); CAPD was performed in 39% of pts. Dialysis modality (CAPD; APD), nutrition parameters (PNA; BMI), as well as RRF, expressed as an average value during follow-up, are shown in Figure 1. 81 patients (30%) were treated with incremental PD; 85% of them with manual exchanges. The comparison of dialysis parameters between incremental PD and standard PD are shown in Figure 2.
Multivariate analysis with survival as dependent variable (Figure 3), showed that age, diabetes mellitus, and low wKt/V were independently associated with an increased risk of mortality. Diuresis volume and male gender were protective factors. No independent influence on mortality of the dialysis treatment modality was found.
Conclusion
In this ten-years experience of patients undergoing PD at our Center, incremental PD seems to be a protective factor for the maintenance of a preserved diuresis and better dialysis adequacy, and these factors are associated with better survival of the patients.
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