Experiences with Assisted Peritoneal Dialysis in China

ObjectiveAbout half the patients on peritoneal dialysis (PD) in China need to be assisted by family members or home assistants. We explored whether these patients have a higher risk for peritonitis and death compared with self-care PD patients.MethodsWe prospectively followed 313 incident PD patients until death or censoring. This cohort was divided into assisted and self-care PD groups according to the independence of bag exchange. Data on baseline demographics, Charlson comorbidity index, biochemistry, and residual renal function were recorded during the first 3 – 6 months. The outcome variables were first episode of peritonitis and all-cause mortality.ResultsOf the 313 patients in this cohort study, 122 needed assistance in performing bag exchanges (86 from a family member, 36 from a home assistant); the remaining 191 patients did not need assistance. During a follow-up period averaging 44.5 months, 122 patients developed a first episode of peritonitis, and 135 patients died. Compared with patients having a family assistant, those with a home assistant had similar peritonitis-free and survival times, but a higher risk of mortality after adjustments for variables such as age, sex, Charlson comorbidity score, hemoglobin, serum albumin, and residual renal function. Furthermore, compared with self-care patients, assisted patients overall had a similar peritonitis-free time, but a higher risk of mortality, even after adjusting for covariates.ConclusionsBased on our single-center experience in China, we conclude that assisted PD is a good option for patients with poor self-care ability. This result provides evidence for recruiting patients who need assistance to PD programs in China.

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P1207ANALYSIS OF OUTCOME AND FACTORS ASSOCIATED WITH MAINTENANCE OF PERITONEAL DIALYSIS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1207 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Merita Rroji (Molla) ◽

Saimir Seferi ◽

Larisa Shehaj ◽

Myftar Barbullushi

Keyword(s):

Renal Function ◽

Peritoneal Dialysis ◽

Residual Renal Function ◽

Good Survival ◽

First Year ◽

Technical Failure ◽

Technique Survival ◽

Ultrafiltration Failure ◽

Comorbidity Index ◽

Short Time

Abstract Background and Aims Peritoneal dialysis (PD) is generally associated with a good survival rate and with great preservation of residual renal function (RRF). The various causes of technique failure are responsible for the relative short time staying in PD. Objectives: This study aimed to analyze the outcome and factors correlated with maintenance peritoneal dialysis (PD) to guide for improving prognosis. Method In a retrospective way we examined our PD-cohort concerning mortality, technique survival, peritonitis rate, and other complications. Results From 2005 to 2019 the number of PD patients who have been treated in PD program for more than 3 months was around 199 patient, 29.1% diabetics, mean age 53.3±15.03 years old and meantime in therapy 32.39± 27.34 months. The PD was seen as an alternative for younger patients in the transplant list and elderly patients with comorbidity. Around 7.5% of the PD patients were transplanted and 8.5 % of patients were transferred from HD due to vascular access failure. Around 88.9% of patients were on PD for more than 1 year, 37.7% from 3 up to 5 years and 19.8% percent of the patients have stayed on PD for more than 5 years. Cardiovascular mortality was the main cause of mortality with 53% of the cases. Higher comorbidity index, lower albumin levels, and lower residual renal function were the main risk factors for lower survival. The technical survival of patients was 92.3% during the first year, 79.5% and 69.6% in the second and the fifth year, respectively. There was not found a difference in technical survival between diabetics and nondiabetics patients. Ultrafiltration failure followed by peritonitis was the main reason for transfer patients with more than 24 months in therapy in hemodialysis probably linked with the no availability of icodextrin. Peritonitis rate was 1:41 patient months. Conclusion PD program in our center is organized based in the concept of integrated care in RRT. The outcome of our patients was at least comparable to those reported by larger registries Although we have done good progress in the prevention of infection the nonavailability of icodextrin is an important factor for a technical failure. RRF is an important factor and we need to be more focused to maintain it longer in the future.

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Rapid Change in Residual Renal Function Decline is Associated with Lower Survival and Worse Residual Renal Function Preservation in Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.3747/pdi.2016.00211 ◽

2017 ◽

Vol 37 (4) ◽

pp. 477-481 ◽

Cited By ~ 6

Author(s):

Susie L. Hu ◽

Priyanka Joshi ◽

Mark Kaplan ◽

Judy Lefkovitz ◽

Andreea Poenariu ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Renal Function ◽

Peritoneal Dialysis ◽

Fold Increase ◽

Residual Renal Function ◽

Rapid Decline ◽

Dialysis Patients ◽

Risk Of Mortality ◽

Increased Risk

The survival advantage observed among peritoneal dialysis patients early on after dialysis initiation has been largely attributed to residual renal function (RRF) preservation due to higher baseline residual function and fewer comorbidities. We hypothesize that a rapid decline in RRF is associated with higher risk of anuria and mortality. In a retrospective cohort study of 581 subjects on peritoneal dialysis with longitudinal prevalent data, we assessed whether RRF change over time, in addition to baseline RRF, increased risk of mortality and anuria using Kaplan-Meier analysis and Cox proportional hazard analysis to control for known risk factors. Rapid RRF decline (≥ 0.09 decline) over a 12-month period was associated with a 2.6-fold increase in the risk of death (hazard ratio [HR] 2.60, 95% confidence interval [CI] 1.66 – 4.07, compared with < 0.09 decline) and a 2-fold increase in anuria (HR 2.06, 95% CI 1.24 – 3.42). Each quartile of increasing severity of RRF decline over a 12-month period increased risk incrementally for death (2ndquartile: HR 3.04, CI 1.26 – 7.34; 3rdquartile: HR 4.01, CI 1.71 – 9.83; 4thquartile HR 5.78, CI 2.10 – 15.9) and generally for anuria (quartiles with HR 5.72 – 7.21). The escalating risk of mortality and anuria was greater for those with diabetes mellitus. In conclusion, rapid decline in RRF over a 12-month period increased the risk of mortality and likewise anuria, beyond previously established risk factors for mortality and anuria. The impact on mortality and RRF preservation was particularly severe for those with diabetes mellitus.

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The “Heart” of Peritoneal Dialysis: Residual Renal Function

Peritoneal Dialysis International ◽

10.1177/089686080702700203 ◽

2007 ◽

Vol 27 (2) ◽

pp. 116-124 ◽

Cited By ~ 13

Author(s):

Angela Yee-Moon Wang

Keyword(s):

Cardiovascular Disease ◽

Renal Function ◽

Peritoneal Dialysis ◽

Predictive Power ◽

Residual Renal Function ◽

Cardiovascular Death ◽

Risk Of Mortality ◽

Small Solute ◽

Solute Clearance

The CANUSA study originally reported the importance of total small-solute clearance in predicting survival of peritoneal dialysis (PD) patients. However, subsequent reanalysis of data from the CANUSA study clearly demonstrated that the predictive power for mortality in PD patients was largely attributable to residual renal function (RRF) and not to the dose of PD. While this should not lead to the assumption that the dose of PD is unimportant, it does clearly indicate that the contribution of residual renal clearance and PD clearance to the overall survival of PD cannot be considered equivalent. In a previous study, we also demonstrated the importance of loss of RRF in predicting a heightened risk of mortality and cardiovascular death in PD patients. In this review, we focus our discussion on the different potential mechanisms that explain the important link between RRF and cardiovascular disease and survival of PD patients. We provide evidence to explain why RRF is so important to patients receiving long-term PD treatment and why it should be regarded as the “heart” of PD.

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The excess weight gain in peritoneal dialysis in the first year and its consequences on the loss of residual renal function.

10.26226/morressier.59a56f96d462b8028d895cb9 ◽

2017 ◽

Author(s):

Lilia Ben Lasfar

Keyword(s):

Renal Function ◽

Peritoneal Dialysis ◽

Weight Gain ◽

Residual Renal Function ◽

Excess Weight ◽

First Year ◽

Excess Weight Gain

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RESIDUAL RENAL FUNCTION IN PERITONEAL DIALYSIS PATIENTS

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2011.4.4 ◽

2011 ◽

pp. 30-34

Author(s):

Hoang Bui Bao Hoang ◽

Huu Loi Le ◽

Tam Vo ◽

Thi Anh Thu Tran

Keyword(s):

Renal Function ◽

Peritoneal Dialysis ◽

Close Correlation ◽

Residual Renal Function ◽

Central Hospital ◽

Dialysis Patients

Background: Peritoneal dialysis is used regularlly in treatment of ESRDs. Residual renal function (RRF) in these patients helps the adequacy of PD therapy very much. Objectives: 1. Study RRF of PD patients at Department of Nephro – Rheumatology, Hue Central Hospital. 2. Search the correlation between RRF and Kt/V. Patients and methods: 35 PD patients at Department of Nephro – Rheumatology, Hue Central Hospital. Measure RRF and Kt/V by formulars that depend on blood, urine and PD fluid samples. Results: Mean RRF of PD patients is 4.36 ± 13.8 ml/minute. There is a close correlation between RRF and Kt/V (r=0.79, p<0.01). Conclusion: RRF in PD patients correlates with Kt/V.

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Predictors of Faster Decline of Residual Renal Function in Taiwanese Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080802803s35 ◽

2008 ◽

Vol 28 (3_suppl) ◽

pp. 191-195 ◽

Cited By ~ 3

Author(s):

Chia-Te Liao ◽

Chih-Chung Shiao ◽

Jenq-Wen Huang ◽

Kuan-Yu Hung ◽

Hsueh-Fang Chuang ◽

...

Keyword(s):

Diabetes Mellitus ◽

Renal Function ◽

Peritoneal Dialysis ◽

Clinical Laboratory ◽

Statistical Significance ◽

Univariate Analysis ◽

Residual Renal Function ◽

Measure Data ◽

Chi Square ◽

Artery Disease

⋄ Objective Loss of residual renal function (RRF) in peritoneal dialysis (PD) patients is a powerful predictor of mortality. The present study was conducted to determine the predictors of faster decline of RRF in PD patients in Taiwan. ⋄ Methods The study enrolled 270 patients starting PD between January 1996 and December 2005 in a single hospital in Taiwan. We calculated RRF as the mean of the sum of 24-hour urea and creatinine clearance. The slope of the decline of residual glomerular filtration rate (GFR) was the main outcome measure. Data on demographic, clinical, laboratory, and treatment parameters; episodes of peritonitis; and hypotensive events were analyzed by Student t-test, Mann–Whitney U-test, and chi-square, as appropriate. All variables with statistical significance were included in a multivariate linear regression model to select the best predictors ( p < 0.05) for faster decline of residual GFR. ⋄ Results All patients commencing PD during the study period were followed for 39.4 ± 24.0 months (median: 35.5 months). The average annual rate of decline of residual GFR was 1.377 ± 1.47 mL/min/m2. On multivariate analysis, presence of diabetes mellitus ( p < 0.001), higher baseline residual GFR ( p < 0.001), hypotensive events ( p = 0.001), use of diuretics ( p = 0.002), and episodes of peritonitis ( p = 0.043) independently predicted faster decline of residual GFR. Male sex, old age, larger body mass index, and presence of coronary artery disease or congestive heart failure were also risk factors on univariate analysis. ⋄ Conclusions Our results suggested that diabetes mellitus, higher baseline residual GFR, hypotensive events, and use of diuretics are independently associated with faster decline of residual GFR in PD patients in Taiwan.

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