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

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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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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How to Improve Survival in Geriatric Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080702702s32 ◽

2007 ◽

Vol 27 (2_suppl) ◽

pp. 185-189 ◽

Cited By ~ 1

Author(s):

Hiramatsu Makoto ◽

Keyword(s):

Peritoneal Dialysis ◽

Elderly Patients ◽

Nursing Care ◽

Causes Of Death ◽

Japanese Society ◽

Patient Survival ◽

The Elderly ◽

Patient Choice ◽

Technique Survival ◽

Included Patient

♦ Background Recently, more elderly patients who are independent or able to live at home with the support of family are opting for continuous ambulatory peritoneal dialysis (CAPD). At the end of 2005, the annual statistical survey conducted by the Japanese Society for Dialysis Therapy indicated that the mean age of patients at initiation of dialysis treatment is 66.2 years. Only 3.6% of the overall end-stage renal disease population were treated with CAPD, and this small number of elderly patients was treated with CAPD despite the many merits of peritoneal dialysis (PD) for the elderly. In the present study, we reviewed our experience with patients 65 years of age and older at the start of PD and the results from two multicenter studies on PD treatment in elderly patients in Japan. ♦ Patients and Methods Study 1: Of 313 PD patients at Okayama Saiseikai General Hospital between January 1991 and June 2006, 166 patients 65 years of age and older were studied. The characteristics of these elderly PD patients were reviewed to determine which elderly patients can continue PD for more than 5 years, and what the causes of death and the effects of icodextrin were in elderly PD patients. Study 2: A multicenter study of 421 patients introduced to PD from April 2000 to December 2004 in Japan was carried out by the Japanese Society for Elderly Patients on Peritoneal Dialysis to retrospectively analyze patient survival and technique survival and to find factors that have the potential to influence prognosis in these patients. Study 3: A review of the PD management and nursing-care insurance system (long-term care insurance) targeted patients 65 years of age and older who were initiated onto PD from January 2000 to June 2002 at 82 centers in Japan. The review found 765 patients under the age of 65 years (62.6%), and 458 patients 65 years of age and over (37.4%). Data on 409 elderly PD patients from 73 centers were analyzed. ♦ Results Study 1: In 166 elderly patients, 27 (16.3%; 18 women, 9 men) continued PD for more than 5 years at our hospital. The original disease was chronic glomerulonephritis in 21 patients, diabetic nephropathy in 2 patients, nephrosclerosis in 2 patients, and polycystic kidney disease in 2 patients. The causes of death in the elderly PD patients at our hospital were heart failure (20.3%), cerebrovascular disease (17.7%), myocardial infarction (15.2%), debilitation (12.7%), peritonitis (7.6%), and pneumonia (3.8%). We observed significant differences in ultrafiltration, body weight, sodium, chloride, red blood cells, and hematocrit after using icodextrin in 14 elderly PD patients. Also, use of icodextrin in the daytime helps the family supporting an elderly member on PD by reducing the number of exchanges. Study 2: The average age of 421 patients in 37 hospitals throughout Japan was 76.4 years. Women accounted for 41% of all patients. The average modified (exclusive of factors of aging) Charlson comorbidity index (CCI) was 3.7. The modified CCI was an important factor not only in patient survival but also in technique survival. Patient survival was significantly different for the three modified CCI groups (CCI < 3, 3 ≤ CCI < 5, 5 ≤ CCI). Factors that influenced patient survival included patient choice of modality, modified CCI, exchanges performed by family members, and age at the start of PD. Factors that influenced technique survival included patient choice of modality, modified CCI, and exchanges performed by family members. Age at the start of PD was not a significant factor influencing technique survival. Study 3: Most elderly PD patients were living with family; 7% were living alone. At the start of PD, 24% of elderly PD patients were covered by nursing-care insurance, including 11% of young elderly patients (65 – 74 years of age), 35% of old elderly patients (75 – 84 years of age), and 29% of very old elderly patients (85 years of age or older). Patients 75 years of age or older were covered by nursing-care insurance more frequently than were patients under 75 years of age. Nevertheless, at the start of dialysis, fewer than 10% of elderly patients were using nursing-care insurance for PD. ♦ Conclusions In elderly patients, PD has good outcomes, especially in nondiabetic patients, in patients with few comorbidities, and in patients managing PD by themselves. In introducing dialysis in elderly patients, PD should be the treatment of choice. A more secure support system should be established to allow the elderly to choose PD treatment.

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A comparison between Chinese finger trap and Roman sandals suturein peritoneal dialysis catheters for chronic kidney disease appliedin veterinary medicine

Industria Textila ◽

10.35530/it.071.01.1722 ◽

2020 ◽

Vol 71 (01) ◽

pp. 8-11

Author(s):

BOGDAN ALEXANDRU VIȚĂLARU ◽

MĂDĂLIN ION RUSU ◽

CARMEN MIHAI ◽

ALEXANDRU CHIOTOROIU

Keyword(s):

Chronic Kidney Disease ◽

Peritoneal Dialysis ◽

Kidney Disease ◽

Chronic Treatment ◽

Chronic Peritoneal Dialysis ◽

Peritoneal Catheter ◽

Catheter Migration ◽

Group A ◽

Initial Placement ◽

Group B

Catheters designed for chronic peritoneal dialysis have Dacron cuffs meant to protect the patient against bacterialinfection and catheter migration that may lead to a high peritonitis rate in case of extensive use. Peritoneal catheter isfixed by suturing the skin with a non-absorbable monofilament thread ranging from 4/0 to 2/0. The two types of suturesmost commonly used are Roman sandal and Chinese fingertrap. In this study we selected 44 dogs, both males andfemales with CKD (Chronic Kidney Disease) undergoing peritoneal dialysis. We have created two groups: first group(A) of 22 patients were treated using a peritoneal catheter for chronic treatment, with Roman sandal suture and thesecond group of 22 patients (B) were treated using a peritoneal catheter for chronic treatment, with Chinese fingertrapsuture. All patients from group A kept the catheters until the end of the treatment (22 out of 22, 100%). Eight out of14 patients (36.36%) from group B needed secondary suture. Four out of the eight patients (18.18%) form the group Bneeded secondary suturing because of the suture weakening. Three out of the eight patients (13.63%) form the groupB needed secondary suturing of the catheter because of the skin rupture at the initial placement spot of the suture. Oneof the eight patients (4.54%) form the group B needed secondary suturing of the catheter because of the catheterreplacement, due to the weakening of the suture and its lack of resistance to the aggression manifested by the patients

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Clinical Study on the Effects of Different Infusion Solutions on Colloid Osmotic Pressure During Major Abdominal Surgery and Perioperative Albumin in Elderly Patients

Journal of Clinical and Nursing Research ◽

10.26689/jcnr.v4i2.1083 ◽

2020 ◽

Vol 4 (2) ◽

Author(s):

Chunyan Zhao ◽

Cibo Chen ◽

Bingchun Xia

Keyword(s):

Abdominal Surgery ◽

Elderly Patients ◽

Osmotic Pressure ◽

Colloid Osmotic Pressure ◽

The Other ◽

Major Abdominal Surgery ◽

Arterial Blood ◽

Group A ◽

Group B ◽

Group D

Objective: To explore the effects of different infusion schemes on colloid osmotic pressure during major abdominal surgery and perioperative albumin in elderly patients. Methods: 140 elderly patients of 65-80 years old undergoing major abdominal surgery were divided into 4 groups according to the method of random number table , and different proportions of crystals and colloids were given to different groups (group A: whole crystal, group B: crystal-colloid ratio 1 : 1, group C: crystal-colloid ratio 2: 1, Group D: crystal-colloid ratio 1: 2). The plasma colloid osmotic pressure and level of albumin during perioperative period were monitored. Simultaneously observe the arterial blood pH, blood glucose, extubating time of endotracheal tube, postoperative feeding time, et al. Results: The total amount of liquid inputted in the group of whole crystal was 3056ml (3056 ± 253), which was significantly increased compared with other groups (P<0.01). At the same time, the colloid osmotic pressure decreased by 11.9 mmHg (11.9 ± 2.8), which was more obviously decreased than that of the other groups( B group3.9 ± 1.3, C group 1.5 ± 0.3, D group 4.7±2.1). The difference was a statistically significant(P<0.01). On the other day after surgery, the level of albumin decreased by an average of 4.3 g / L (4.5 ± 1.9) compared with that in group B before surgery, and group C decreased by 2.9 g / L (2.9 ± 1.2) in average, which was significantly different (P<0.05) from group A 10.2 g / L (10.2 ± 1.8). There was no statistically significant difference between group A and group D (P>0.05). And the other indexes were not significantly different between the two groups. Conclusion: This study found that different infusion solutions with different crystal-colloid ratios had an effect on perioperative colloid osmotic pressure and level of albumin.

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Emergent Start Peritoneal Dialysis for End-Stage Renal Disease: Outcomes and Advantages

Blood Purification ◽

10.1159/000486543 ◽

2018 ◽

Vol 45 (4) ◽

pp. 313-319 ◽

Cited By ~ 9

Author(s):

K. Shivanand Nayak ◽

Sreepada V. Subhramanyam ◽

Navva Pavankumar ◽

Sinoj Antony ◽

M.A. Sarfaraz Khan

Keyword(s):

Peritoneal Dialysis ◽

Venous Catheter ◽

Catheter Insertion ◽

Secondary Outcome ◽

Control Group ◽

Study Group ◽

Technique Survival ◽

Group A ◽

Presentation Methods ◽

Group B

Background/Aims: Initiating renal replacement therapy in late referred patients with central venous catheter (CVC) hemodialysis (HD) causes serious complications. In urgent start peritoneal dialysis, initiating peritoneal dialysis (PD) within 14 days of catheter insertion still needs HD with CVC. We initiated Emergent start PD (ESPD) with Automated PD (APD) at our center within 48 h from the time of presentation. Methods: A prospective, case-controlled, intention-to-treat study with 56 patients was conducted between March 2016 and August 2017. Group A (24 patients) underwent conventional PD 14 days after catheter insertion. Group B (32 patients), underwent ESPD with APD. Exit site leak (ESL), catheter blockage, and peritonitis at 90 days were primary outcomes. Technique survival was secondary outcome. Results: Baseline characteristics were similar with 3 episodes of ESLs (9.4%) in the study group and none in the control group (p = 0.123). Catheter blockage (16.7%-Group A, 25%-Group B) and peritonitis (none vs. 9.4% in study group) were similar in terms of statistical details just as technique survival (95%-Group A, 88.2%-Group B at 90 days). Conclusion: ESPD with APD in the unplanned patient is an appropriate approach.

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Quality of Life in Elderly Continuous Ambulatory Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080302302s20 ◽

2003 ◽

Vol 23 (2_suppl) ◽

pp. 95-98 ◽

Cited By ~ 6

Author(s):

Ai-wu Lin ◽

Jia-qi Qian ◽

Qi-ang Yao ◽

Ai-ping Gu

Keyword(s):

Quality Of Life ◽

Peritoneal Dialysis ◽

Elderly Patients ◽

Serum Albumin ◽

Lipid Profile ◽

Short Form ◽

Sf 36 ◽

Group A ◽

Group B

Objective In the present study, we determined the characteristic of quality of life (QOL) in elderly peritoneal dialysis (PD) patients by using the Medical Outcomes Study Short Form 36 (SF-36) to compare QOL between two age groups of continuous ambulatory PD patients. Patients and Methods Patients were allocated to one of two groups according to age: patients in group A were ≥65 years of age, and patients in group B were <65 years of age. We compared SF-36 scores, serum albumin, prealbumin, hemoglobin, lipid profile, normalized protein catabolic rate (nPCR), dialysis adequacy (Kt/V), creatinine clearance (CCr), and glomerular filtration rate (GFR) between the two groups. Results Group A contained 25 patients, and group B, 53 patients. Mean age in the two groups was 68.6 ± 3.3 years and 47.7 ± 10.2 years respectively. Elderly patients showed lower QOL scores with regard to physical problems. Quality-of-life scores with regard to psychological problems were similar in the two groups. Duration of PD, body mass index, serum albumin, prealbumin, hemoglobin, and lipid profile were not different between the two groups. However, nPCR, GFR, and total solute clearance were lower in group A than in group B (nPCR: 0.70 ± 0.13 g/kg daily vs 0.95 ± 0.21 g/kg daily, p < 0.001; GFR: 1.03 ± 1.21 mL/min vs 3.19 ± 2.22 mL/min, p < 0.001). Conclusions In elderly patients, QOL scores were lower, mainly because of a perception of being more physically impaired. Nutritional indices and QOL scores reflecting psychological processes were similar between the two groups. These descriptive data show that PD is an ideal choice in elderly patients with end-stage renal disease. More attention needs to be paid to “healthy start” dialysis and maintenance of nutritional status in elderly patients because of lower GFR and nPCR.

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Good Patient and Technique Survival in Elderly Patients on Continuous Ambulatory Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686080702702s34 ◽

2007 ◽

Vol 27 (2_suppl) ◽

pp. 196-201 ◽

Cited By ~ 1

Author(s):

Philip Kam-Tao Li ◽

Man Ching Law ◽

Kai Ming Chow ◽

Chi-Bon Leung ◽

Bonnie Ching-Ha Kwan ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Elderly Patients ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Patient Survival ◽

Self Care ◽

The Elderly ◽

Elderly Group ◽

Control Group ◽

Technique Survival ◽

Esrd Patients

The aging population has significant implications for the community. The increasing number of elderly end-stage renal disease (ESRD) patients presses the renal team to find an appropriate management plan. We used a retrospective analysis to study the effectiveness of continuous ambulatory peritoneal dialysis (CAPD) in elderly ESRD patients. Of the 328 CAPD patients recruited for the study, 121 were in the elderly group (≥ 65 years of age), and 207 were in the control group (under 65 years of age). Median age in the elderly group was 71 years, and in the control group, 51 years. The elderly group had a higher prevalence (54.5%) of diabetes mellitus. The 2-year and 5-year rates of patient survival were 89.3% and 54.8% respectively in the elderly group and 92.2% and 62.9% in the control group ( p = 0.19). The 2-year and 5-year rates of technique survival were 84.0% and 45.7% respectively in the elderly group and 80.9% and 49.1% in the control group ( p = 0.75). The probability of a 12-month peritonitis-free period was 76.6% in the elderly group and 76.5% in the control group ( p = 0.75). One hundred elderly patients (82.6% of the group) performed their CAPD exchanges by themselves. We observed no significant difference in clinical outcome—including patient survival, technique survival, and peritonitis-free period—between the elderly self-care CAPD and the elderly assisted CAPD groups. In elderly ESRD patients, CAPD is an effective dialysis modality. A slightly longer training time is to be expected for elderly patients. Self-care CAPD for elderly patients who are capable of performing their own exchanges provides them with an independent home life.

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Management of Fungal Peritonitis during Continuous Ambulatory Peritoneal Dialysis (CAPD)

Peritoneal Dialysis International ◽

10.1177/089686088600600106 ◽

1986 ◽

Vol 6 (1) ◽

pp. 17-20 ◽

Cited By ~ 12

Author(s):

Vargemezis Zoe L. Vassilis ◽

Homer Papadopoulou ◽

Anna-Maria Liamos ◽

Taisir Natscheh Belechri ◽

George Vergoulas ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Peritoneal Lavage ◽

Pathogenic Fungi ◽

Significant Loss ◽

The Other ◽

Peritoneal Adhesions ◽

Fungal Peritonitis ◽

Group A ◽

Group B

A group of 138 patients (pts) on CAPD for a total of 1889 patientmonths had 176 episodes of peritonitis. Eighteen (13%) had fungal peritonitis at one to 20 months after beginning CAPD. The responsible organisms were Candida albicans (nine pts), Candida parapsilosis (five), Candida torulopsis (three), and Trichosporum capitatum (one). These infections were treated by various combinations of antifungal agents using two different strategies: Removal of the Tenckhoff catheter and interruption of CAPD for 10 to 14 days in nine pts (Group A), and continuous peritoneal lavage for four to six days in the remainder -nine pts (Group B). Fourteen of the 18 were cured (seven of nine in each group). In group A, two patients died, one continues on CAPD while the other six (67%) were transferred to hemodialysis because they developed peritoneal adhesions with significant loss in peritoneal space. In group B, only two patients have been transferred to hemodialysis; the other seven continue on CAPD. In our experience, the preferred initial form of treatment is continuous peritoneal lavage in conjunction with antifungal therapy. Catheter removal should be reserved for those who fail to respond to this treatment. Continuous ambulatory peritoneal dialysis (CAPD) is now accepted as a alternative treatment for end-stage renal disease. However, despite continuous progress in this field, peritonitis still remains a major complication and results in increased morbidity and cost. Although pathogenic fungi account for only 2 7% of peritonitis in patients on CAPD (1–3), the illness is severe and represents a major clinical challenge to these patients. In addition, the therapy of fungal peritonitis is still controversial, especially with regard to the need for removal of the catheter. This paper presents a retrospective study and describes our experience during the past four years with the management of fungal peritonitis in 18 patients undergoing CAPD at our center.

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Bioimpedance Guided Fluid Management in Peritoneal Dialysis

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.06480619 ◽

2020 ◽

Vol 15 (5) ◽

pp. 685-694 ◽

Cited By ~ 2

Author(s):

Na Tian ◽

Xiao Yang ◽

Qunying Guo ◽

Qian Zhou ◽

Chunyan Yi ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Patient Survival ◽

Fluid Management ◽

Volume Overload ◽

Short Term ◽

Cardiovascular Disease Mortality ◽

Technique Survival ◽

Disease Mortality ◽

Clinical Methods ◽

And Control

Background and objectivesBioelectrical impedance analysis (BIA) devices can help assess volume overload in patients receiving maintenance peritoneal dialysis. However, the effects of BIA on the short-term hard end points of peritoneal dialysis lack consistency. This study aimed to test whether BIA-guided fluid management could improve short-term outcomes in patients on peritoneal dialysis.Design, setting, participants, & measurementsA single-center, open-labeled, randomized, controlled trial was conducted. Patients on prevalent peritoneal dialysis with volume overload were recruited from July 1, 2013 to March 30, 2014 and followed for 1 year in the initial protocol. All participants with volume overload were 1:1 randomized to the BIA-guided arm (BIA and traditional clinical methods) and control arm (only traditional clinical methods). The primary end point was all-cause mortality and secondary end points were cardiovascular disease mortality and technique survival.ResultsA total of 240 patients (mean age, 49 years; men, 51%; diabetic, 21%, 120 per group) were enrolled. After 1-year follow-up, 11(5%) patients died (three in BIA versus eight in control) and 21 patients were permanently transferred to hemodialysis (eight in BIA versus 13 in control). The rate of extracellular water/total body water decline in the BIA group was significantly higher than that in the control group. The 1-year patient survival rates were 96% and 92% in BIA and control groups, respectively. No significant statistical differences were found between patients randomized to the BIA-guided or control arm in terms of patient survival, cardiovascular disease mortality, and technique survival (P>0.05).ConclusionsAlthough BIA-guided fluid management improved the fluid overload status better than the traditional clinical method, no significant effect was found on 1-year patient survival and technique survival in patients on peritoneal dialysis.

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