Dialysis Outcomes in a Middle-Income Country: An Updated Comparison of Patient Mortality between Hemodialysis and Peritoneal Dialysis

2021 ◽  
pp. 1-11
Author(s):  
Rafael M. Sanabria ◽  
Jasmin I. Vesga ◽  
David W. Johnson ◽  
Angela S. Rivera ◽  
Giancarlo Buitrago ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Mortality Rate ◽  
Kidney Failure ◽  
Middle Income Country ◽  
Dialysis Modality ◽  
Middle Income ◽  
Cumulative Mortality ◽  
Parametric Survival Model ◽  
Parametric Survival

<b><i>Introduction:</i></b> Comparisons of survival between dialysis modalities is of great importance to patients with kidney failure, their families, and healthcare systems. <b><i>Objective:</i></b> This study’s objective was to compare mortality of patients on chronic hemodialysis (HD) or peritoneal dialysis (PD) and identify variables associated with mortality. <b><i>Methods:</i></b> This retrospective cohort study included adult incident patients with kidney failure treated with HD or PD by the Baxter Renal Care Services network in Colombia. The study was conducted between January 1, 2008, and December 31, 2013 (recruitment period), with follow-up until December 31, 2018. The outcome was the cumulative mortality rate at 1, 2, 3, 4, and 5 years. Propensity score matching (PSM) and the Gompertz parametric survival model were used to compare mortality in HD versus PD. <b><i>Results:</i></b> The analysis included 12,499 patients, of whom 57.4% were on PD at inception. The overall mortality rate was 14.0 events per 100 patient-years (95% confidence interval [CI], 13.61–14.42). Using an intention-to-treat approach, crude mortality rates were significantly lower in patients receiving HD (HD: 12.3 deaths per 100 patient-years [95% CI, 11.7–12.8] vs. PD: 15.5 [14.9–16.1], <i>p</i> &#x3c; 0.01). Using a Gompertz parametric survival model, dialysis modality was not significantly associated with mortality (hazard ratio HD vs. PD 1.0, 95% CI, 0.9–1.1). After PSM, the mortality cumulative incidence functions between HD and PD were not statistically significantly different (<i>p</i> = 0.88). <b><i>Conclusions:</i></b> The present study in a large cohort of incident dialysis patients with at least 5 years follow-up and using PSM methods showed no differences in cumulative mortality between HD and PD patients. This evidence from a middle-income country may facilitate the process of dialysis modality selection globally.

scholarly journals Adherence and persistence of optimal medical therapy after myocardial infarction in a low to middle income country

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Villalobos-Pedroza ◽  
AP Flores-Batres ◽  
E Rivera-Pedrote ◽  
AA Brindis-Aranda ◽  
A Jara-Nevarez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Medical Therapy ◽  
Middle Income Country ◽  
Income Country ◽  
Survey Study ◽  
Middle Income ◽  
Common Mean ◽  
Coronary Syndrome ◽  
Adherence To Medication

Abstract Funding Acknowledgements Type of funding sources: None. Background Adherence to medical therapy after myocardial infarction (MI) is a crucial part of patient care and indispensable for reaching clinical goals, however, data from low to middle income countries (LMIC) regarding adherence and persistence of optimal medical treatment (OMT) is scarce. Purpose To evaluate adherence and persistence to OMT after acute coronary syndrome (ACS) in a cohort of patients with ST elevation myocardial infarction (STEMI) in a low to middle income country. Methods We conducted a survey study evaluating adherence and persistence of OMT after 6 months of the index event in patients with STEMI. Patients were surveyed via phone call using the simplified medication adherence questionnaire (SMAQ) tool, which has been previously validated (both in English and Spanish) as a clinical tool to evaluate adherence to medication. We evaluated persistence of OMT as well. A secure electronic database was constructed to capture information, regarding adherence and persistence, and other clinically relevant variables. Study population The study included consecutive patients aged 18-99 years old with the diagnosis of STEMI form Mexico City’s STEMI Network, who received either pharmacoinvasive strategy (PIS) or Primary Percutaneous Coronary Intervention (pPCI) during the first 12 hours from symptom onset. This population is derived from the PHASE-Mx study (ClinicalTrials.gov Identifier: NCT03974581), which results have been previously published. Results A total of 602 patients were initially screened; among these, 158 patients (26.2%) were lost to contact, 5 patients (n = 0.008%) refused to answer and 65 patients (10.7%) died during follow up. The final analytic sample consisted of 375 patients; among them, 192 (51.2%) received primary PCI and 183 (48.8%) received pharmacoinvasive strategy. Mean age was 58 + 10 years old and most of the patients were male (90.1%). Hypertension (44.8%) and diabetes (32.0%) were common. Mean follow-up time after index STEMI was 650 (IQR: 416-832) days. After SMAQ evaluation, only 26.1% of the patients were considered to be adherent to their medications (&gt;95% compliance), as shown in the Table 1. Persistence of OMT after STEMI included: ASA (84.6%), P2Y12i (71.5%), statin (83.6%), ACEI/ARB (77.1%) and beta blocker (63.7%) (Table 2). Conclusions In patients with STEMI in a low to middle income country, persistence and adherence to OMT were low. Actions to improve adherence to therapy after mayor cardiovascular events are needed. Risk factors associated to poor adherence included diabetes (OR 0.46), age (OR 0.76) and atrial fibrillation (OR 0.42). Abstract Figure.

Life After Capo

1983 ◽  
Vol 3 (3_suppl) ◽  
pp. 51-53
Author(s):  
Clair C. Williams
Keyword(s):  
Peritoneal Dialysis ◽  
Treatment Options ◽  
Drop Out ◽  
Advanced Age ◽  
Dialysis Modality ◽  
Short History ◽  
Drop Out Rate ◽  
Stage Renal Disease ◽  
End Stage

Of 508 patients trained for CAPD during the first five years, 115 (22.6%) were transferred to an alternative dialysis modality. Of these 87% were transferred to centre dialysis programs, equally divided between hemodialysis and intermittent peritoneal dialysis. Advanced age favoured transfer to intermittent peritoneal dialysis and failure due to peritonitis, transfer to hemodialysis. Three year survival after transfer from CAPD was 38%. The presence of diabetes and advanced age adversely affected survival after transfer. Dialysis modality and peritonitis as the cause of CAPD failure did not affect survival. Other treatment options are available to patients who fail CAPD. A relatively high drop-out is therefore acceptable and preferable to continuing CAPD in patients encountering complications which might ultimately influence their survival. Since its introduction in Toronto in 1977, continuous ambulatory peritoneal dialysis (CAPD) has achieved increasing prominence in the management of end-stage renal disease. Throughout its comparatively short history, one of the major criticisms of this technique has been the relatively high drop-out rate. This report provides a follow-up of patients transferred from CAPD to alternative dialysis modalities.

scholarly journals P1145ADEQUACY AND SURVIVAL IN PERITONEAL DIALYSIS: TEN YEARS EXPERIENCE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Vincenzo Terlizzi ◽  
Elena Pezzini ◽  
Roberta Cortinovis ◽  
Diana Bertoni ◽  
Alessandra Pola ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Peritoneal Dialysis ◽  
Protective Factor ◽  
Residual Renal Function ◽  
Dialysis Modality ◽  
Dialysis Adequacy ◽  
Dialysis Treatment ◽  
Increased Risk ◽  
Uremic Patients

Figure: 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.

scholarly journals Comparison of Mortality between Japanese Peritoneal Dialysis and Hemodialysis Patients: A 5-Year Multicenter Follow-Up Study

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Kazuko Suzuki ◽  
Tsuneo Konta ◽  
Kazunobu Ichikawa ◽  
Ami Ikeda ◽  
Hiroki Niino ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Japanese Patients ◽  
Diabetic Patients ◽  
Dialysis Modality ◽  
Multicenter Observational Study ◽  
Kaplan Meier ◽  
The Difference ◽  
Cox Analysis ◽  
The Relationship

To examine the relationship between dialysis modality and prognosis in Japanese patients, we conducted a prospective multicenter observational study. We recruited 83 background-matched peritoneal dialysis (PD) and 83 hemodialysis (HD) patients (average age, 64.9 years; men, 53.6%; diabetic patients, 22.9%; median duration of dialysis, 48 months in all patients) and followed them for 5 years. During the follow-up period, 27 PD patients (16 cardiovascular and 11 non-cardiovascular deaths) and 27 HD patients died (14 cardiovascular and 13 non-cardiovascular deaths). There were 8 PD patients switched to HD, and 6 PD patients received renal transplantation. Kaplan-Meier analysis revealed that the crude survival rate was not significantly different at the end of 5 years (PD 67.5% versus 67.5%, log-rankP=0.719). The difference in cardiovascular and non-cardiovascular mortalities between PD and HD was not statistically significant. Multivariate Cox analysis showed that the independent predictors for death were age and serum albumin levels, but not the dialysis modality. This study showed that the overall mortality was not significantly different between PD and HD patients, which suggests that dialysis modality might not be an independent factor for survival in Japanese patients.

scholarly journals Lessons learnt from enrolment and follow up of pregnant women and their infants in clinical trials in South Africa, a low-middle income country

Vaccine ◽  
2015 ◽  
Vol 33 (47) ◽  
pp. 6406-6412 ◽  
Author(s):  
Clare L. Cutland ◽  
Marianne Cunnington ◽  
Morounfolu Olugbosi ◽  
Stephanie A. Jones ◽  
Andrea Hugo ◽  
...  
Keyword(s):  
South Africa ◽  
Clinical Trials ◽  
Pregnant Women ◽  
Middle Income Country ◽  
Income Country ◽  
Middle Income ◽  
Lessons Learnt

scholarly journals Effect of dialysis modality on the survival of end-stage renal disease patients starting dialysis in Sabah from 2007 to 2017: a retrospective cohort study

2021 ◽  
Author(s):  
Thamron Keowmani ◽  
Anis Kausar Ghazali ◽  
Najib Majdi Yaacob ◽  
Koh Wei Wong
Keyword(s):  
Cohort Study ◽  
Peritoneal Dialysis ◽  
Confidence Interval ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Retrospective Cohort ◽  
Dialysis Modality ◽  
Stage Renal Disease ◽  
End Stage

Background: The effect of dialysis modality on the survival of end-stage renal disease patients is a major public health interest. Methods: In this retrospective cohort study, all adult end-stage renal disease patients receiving dialysis treatment in Sabah between January 1, 2007 and December 31, 2017 as identified from the Malaysian Dialysis and Transplant Registry were evaluated and followed up through December 31, 2018. The endpoint was all-cause mortality. The observation time was defined as the time from the date of dialysis initiation after the onset of end-stage renal disease to whichever of the following that came first: date of death, date of transplantation, date of last follow-up, date of recovered kidney function, or December 31, 2018. Weighted Cox regression was used to estimate the effect of dialysis modality. Analyses were restricted to patients with complete data on all variables. Results: 1,837 patients began hemodialysis and 156 patients started with peritoneal dialysis, yielding 7,548.10 (potential median 5.48 years/person) and 747.98 (potential median 5.68 years/person) person-years of observation. 3.1% of patients were lost to follow-up. The median survival time was 5.8 years (95% confidence interval: 5.4, 6.3) among patients who started on hemodialysis and 7.0 years (95% confidence interval: 5.9, indeterminate) among those who started on peritoneal dialysis. The effect of dialysis modality was not significant after controlling for confounders. The average hazard ratio was 0.80 (95% confidence interval: 0.61, 1.05) with hemodialysis as a reference. Conclusion: There was no evidence of a difference in mortality between hemodialysis and peritoneal dialysis.

scholarly journals A comparison of mortality between patients treated with hemodialysis and peritoneal dialysis.

1995 ◽  
Vol 6 (2) ◽  
pp. 177-183
Author(s):  
W E Bloembergen ◽  
F K Port ◽  
E A Mauger ◽  
R A Wolfe
Keyword(s):  
Peritoneal Dialysis ◽  
Mortality Rate ◽  
High Mortality ◽  
Epidemiologic Study ◽  
National Sample ◽  
National Study ◽  
Dialysis Patients ◽  
All Cause Mortality ◽  
Males And Females

Patients with ESRD treated with dialysis have a high mortality rate. Controversy exists as to whether this high mortality rate is affected by modality choice. The purpose of this epidemiologic study was to compare mortality in prevalent hemodialysis-treated (HD) and peritoneal dialysis-treated (PD) patients in a large national sample, adjusting for demographic characteristics. Data were obtained from the U.S. Renal Data System for patients prevalent on January 1 of the years 1987, 1988, and 1989, each with 1 yr of follow-up. Patients were censored at transplantation. Death rates per 100 patient years were compared between HD and PD, adjusting for age, race, gender, cause of ESRD (diabetes versus nondiabetes) and < 1 yr or > 1 yr of prior ESRD, by the use of Poisson regression. There were 42,372 deaths occurring over 170,700 patient years at risk. On average, prevalent patients treated with PD had a 19% higher adjusted mortality risk (relative risk (RR) = 1.19; P < 0.001) than did those treated with HD. This risk was found to be insignificant (P > 0.05) and small for ages < 55 and increasingly large and significant for ages > 55 yr. It was accentuated in diabetics (RR = 1.38; P < 0.001) but was also present in nondiabetics (RR = 1.11; P < 0.001). Although present in both males and females, this risk was accentuated in females (RR = 1.30 versus 1.11; both P < 0.001). In this national study of prevalent U.S. dialysis patients, treatment assignment to PD was associated with a 19% higher all-cause mortality rate than HD.(ABSTRACT TRUNCATED AT 250 WORDS)

Fifteen-Year Follow-Up of Stapedotomy Patients: Audiological Outcomes and Associated Factors in a Middle Income Country

2020 ◽  
pp. 1-8
Author(s):  
Daniel Peñaranda ◽  
Sergio Moreno ◽  
Felipe Montes ◽  
Juan Manuel Garcia ◽  
Zulehima Rico ◽  
...  
Keyword(s):  
Associated Factors ◽  
Middle Income Country ◽  
Income Country ◽  
Middle Income
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