Initial Glucose Load Predicts Technique Survival in Patients on Chronic Peritoneal Dialysis

Background, Objectives, and Methods The number of patients on chronic peritoneal dialysis (CPD) is increasing rapidly on a global scale. We analyzed the International Pediatric Peritoneal Dialysis Network (IPPN) registry, a global database active in 33 countries spanning a wide range in gross national income (GNI), to identify the impact of economic conditions on CPD practices and outcomes in children and adolescents. Results We observed close associations of GNI with the fraction of very young patients on dialysis, the presence and number of comorbidities, the prevalence of patients with unexplained causes of end-stage kidney disease, and the rate of culture-negative peritonitis. The prevalence of automated PD increased with GNI, but was 46% even in the lowest GNI stratum. The GNI stratum also affected the use of biocompatible peritoneal dialysis fluids, enteral tube feeding, calcium-free phosphate binders, active vitamin D analogs, and erythropoiesis-stimulating agents (ESAs). Patient mortality was strongly affected by GNI (hazard ratio per $10 000: 3.3; 95% confidence interval: 2.0 to 5.5) independently of young patient age and the number of comorbidities present. Patients from low-income countries tended to die more often from infections unrelated to CPD (5 of 9 vs 15 of 61, p = 0.1). The GNI was also a strong independent predictor of standardized height ( p < 0.0001), adding to the impact of congenital renal disease, anuria, age at PD start, and dialysis vintage. Patients from the lower economic strata (GNI < $18 000) had higher serum parathyroid hormone (PTH) and lower serum calcium, and achieved lower hemoglobin concentrations. No impact of GNI was observed with regard to CPD technique survival or peritonitis incidence. Conclusions We conclude that CPD is practiced successfully, albeit with major regional variation related to economic differences, in children around the globe. The variations encompass the acceptance of very young patients and those with associated comorbidities to chronic dialysis programs, the use of automated PD and expensive drugs, and the diagnostic management of peritonitis. These variations in practice related to economic difference do not appear to affect PD technique survival; however, economic conditions seem to affect mortality on dialysis and standardized height, a marker of global child morbidity.

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Unexplained Exudative Pleural Effusion in Chronic Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.3747/pdi.2009.00135 ◽

2010 ◽

Vol 30 (5) ◽

pp. 534-540 ◽

Cited By ~ 7

Author(s):

Bonnie Ching-Ha Kwan ◽

Kai-Ming Chow ◽

Wing-Fai Pang ◽

Chi-Bon Leung ◽

Philip Kam-Tao Li ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Pleural Effusion ◽

Clinical Outcome ◽

Clinical Significance ◽

Fluid Overload ◽

Chronic Peritoneal Dialysis ◽

Dialysis Patients ◽

Actuarial Survival ◽

Technique Survival ◽

Exudative Pleural Effusion

BackgroundAlthough the clinico-pathological entity of uremic pleuritis has long been recognized, its clinical significance remains poorly defined.MethodsWe retrospectively studied 82 chronic peritoneal dialysis (PD) patients that had pleural effusion. The pattern of diagnosis and clinical outcome were reviewed.Results10 patients had overt fluid overload and thoracocentesis was not performed, 23 had other specific diagnoses, 15 had transudative effusion due to fluid overload, 12 had unexplained transudative effusion, and 22 patients had unexplained exudative effusion. The 3-year actuarial survival was 40.9% and 83.3% for patients with unexplained exudative and transudative effusion respectively ( p = 0.012); technique survival was 74.2% and 90.9% respectively ( p = 0.006). For patients with unexplained exudative effusion, 11 patients had their PD regimen intensified: they had a higher 3-year actuarial survival than those with their dialysis regimen unchanged (100.0% vs 52.6%, p = 0.04).ConclusionUnexplained exudative pleural effusion is not uncommon in chronic PD patients. These patients have a high mortality; an intensive dialysis regimen may be considered.

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Clinical Outcome in Elderly Patients on Chronic Peritoneal Dialysis: A Retrospective Study from a Single Center in China

Peritoneal Dialysis International ◽

10.3747/pdi.2012.00209 ◽

2014 ◽

Vol 34 (3) ◽

pp. 299-307 ◽

Cited By ~ 11

Author(s):

Upendra Joshi ◽

Qunying Guo ◽

Chunyan Yi ◽

Rong Huang ◽

Zhijian Li ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Elderly Patients ◽

Serum Albumin ◽

Patient Survival ◽

Survival Rates ◽

The Elderly ◽

Elderly Group ◽

Chronic Peritoneal Dialysis ◽

Lower Serum ◽

Technique Survival

ObjectivesWe aimed to evaluate clinical outcomes and identify the predictors of mortality in elderly patients undergoing continuous ambulatory peritoneal dialysis (CAPD).MethodsThis retrospective cohort study included all incident CAPD patients treated at our center from 2006 to 2009. Demographic and clinical data on initiation of CAPD and clinical events during the study period were collected. Survival probabilities were generated using the Kaplan–Meier method, and risk factors for mortality were evaluated using Cox proportional hazards models.ResultsOf 805 patients on CAPD, the elderly group (≥65 years; mean age: 71.3 ± 4.3 years) consisted of 148 patients, and the younger group (<65 years; mean age: 43.1 ± 12.2years) consisted of 657 patients. The 1-, 2-, 3-, and 5-year patient survival rates were 97%, 92%, 88%, and 73% for the younger group, and 79%, 67%, 56%, and 30% for elderly group. The patient survival rates were significantly lower for the elderly group than for the younger group ( p = 0.000). However, technique survival did not significantly differ between the groups ( p = 0.559). In the patients overall, the independent predictors of death were old age ( p = 0.003), diabetes ( p = 0.000), cardiovascular disease ( p = 0.006), lower hemoglobin ( p = 0.010), and lower serum albumin ( p = 0.024). Mortality in the elderly patients was associated with advanced age [relative risk (RR): 1.088; 95% confidence interval (CI): 1.027 to 1.153; p = 0.004], diabetes (RR: 2.064; 95% CI: 1.236 to 3.445; p = 0.006), and lower serum albumin (RR: 0.940; 95% CI: 0.897 to 0.985; p = 0.010).ConclusionsThe elderly patients on CAPD experienced technique survival comparable with that of younger patients, but their patient survival was lower. In elderly patients, mortality was determined predominantly by greater age, diabetes, and lower serum albumin. Our results indicate that chronic peritoneal dialysis is a viable dialysis option for elderly patients with end-stage renal disease. Better management of hypoalbuminemia and comorbid conditions might improve survival in elderly PD patients.

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Twenty years’ pediatric chronic peritoneal dialysis in Uruguay: patient and technique survival

Pediatric Nephrology ◽

10.1007/s00467-005-1939-0 ◽

2005 ◽

Vol 20 (9) ◽

pp. 1315-1319 ◽

Cited By ~ 10

Author(s):

Jose Grünberg ◽

María Cristina Verocay ◽

Anabella Rébori ◽

Virginia Ramela ◽

Carmen Amaral ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Chronic Peritoneal Dialysis ◽

Technique Survival

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Survival on Chronic Peritoneal Dialysis: Have Results Improved in the 1990s?

Peritoneal Dialysis International ◽

10.1177/089686089601601s79 ◽

1996 ◽

Vol 16 (1_suppl) ◽

pp. 410-413 ◽

Cited By ~ 5

Author(s):

Ana Rodríguez-Carmona ◽

Teresa García Falcon ◽

Miguel pérez Fontán ◽

Pablo Bouza ◽

Magdalena Adeva ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Elderly Patients ◽

Patient Survival ◽

Time Lapse ◽

The Other ◽

Second Phase ◽

Chronic Peritoneal Dialysis ◽

Technique Survival ◽

Group A ◽

Group B

One hundred and seventy patients were treated with home peritoneal dialysis (PD) in our unit between 1986 and 1994. During this time lapse, several technical improvements were included in our practice. Among others there were: Swan neck permanent catheters, Y-systems, and automated home PD (APD). We reviewed our experience, to assess if these improvements had any impact on patient and technique survival, comparing patients who started PD between 1986 and 1989 (group A), with those who started PD between 1990 and 1994 (group B). Both groups had a comparable basal comorbidity, except for a higher proportion of elderly patients in group B (mean age 48 vs 58 years, p < 0.01). The incidence of peritonitis was lower in group B, while there were no differences in the rates of catheter-related infection or hospital admission. Also, there were no significant differences in patient or technique survival. The increasing presence of elderly patients in our PD unit was, apparently, determinant for the evolution of patient survival. On the other side, technical improvements had a marginal impact on technique survival. A good general PD survival in both groups, with few patients changing to hemodialysis (HD), may explain the lack of significant differences. In addition, peritonitis and inadequate PD/ultrafiltration (UF) were replaced by abdominal surgical events and social reasons as the main causes for PD failure in the second phase of the study.

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Prevalence of peritonitis and mortality in patients with ESKD treated with chronic peritoneal dialysis in Africa: a systematic review

BMJ Open ◽

10.1136/bmjopen-2020-039970 ◽

2020 ◽

Vol 10 (12) ◽

pp. e039970

Author(s):

Ikechi G Okpechi ◽

Udeme Ekrikpo ◽

Mothusi W Moloi ◽

Jean Jacques Noubiap ◽

Ugochi S Okpechi-Samuel ◽

...

Keyword(s):

Systematic Review ◽

Peritoneal Dialysis ◽

Data Extraction ◽

Chronic Peritoneal Dialysis ◽

African Countries ◽

Eligibility Criteria ◽

Technique Survival ◽

Median Proportion ◽

Registration Number ◽

End Stage

ObjectiveThe aim of this study was to report the prevalence of peritonitis and mortality in patients with end-stage kidney disease (ESKD) treated with chronic peritoneal dialysis (PD) in Africa.DesignSystematic review.SettingAfrica.ParticipantsPatients with ESKD in Africa.InterventionsPD in its varied forms.Primary and secondary outcomesPD-related peritonitis rate (primary outcome), time-to-discontinuation of PD, mortality.Data sourcesFour databases, including PubMed, Embase, Web of Science and Africa Journal Online were systematically searched from 1 January 1980 to 31 December 2019.Eligibility criteriaStudies conducted in Africa reporting peritonitis rate and mortality in patients treated with PD.Data extraction and synthesisTwo reviewers extracted and synthesised the data using Microsoft Excel. The quality of included data was also assessed.ResultsWe included 17 studies from seven African countries representing 1894 patients treated with PD. The overall median age was 41.4 years (IQR: 38.2–44.7) with a median time on PD of 18.0 months (17.0–22.6). An overall median peritonitis rate of 0.75 (0.56–2.20) episodes per patient-year (PPY) was observed and had declined with time; peritonitis rate was higher in paediatric studies than adult studies (1.78 (1.26–2.25) vs 0.63 (0.55–1.87) episodes PPY). The overall median proportion of deaths was 21.1% (16.2–25.8). Culture negative peritonitis was common in paediatric studies and studies that reported combined outcomes of continuous ambulatory PD and automated PD. Both 1-year and 2-year technique survival were low in all studies (83.6% and 53.0%, respectively) and were responsible for a high proportion of modality switch.ConclusionsOur study identifies that there is still high but declining peritonitis rates as well as low technique and patient survival in PD studies conducted in Africa. Sustained efforts should continue to mitigate factors associated with peritonitis in patients with ESKD treated with PD in Africa.PROSPERO registration numberCRD42017072966.

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