Impact of Break-In Period on the Short-Term Outcomes of Patients Started on Peritoneal Dialysis

ObjectivesPeritoneal dialysis (PD) is one of the first-line modalities of renal replacement therapy in patients with end-stage renal disease. Guidelines recommended a break-in period of at least 2 weeks before full PD start. However, the optimal duration of the break-in period is still unclear. In the present study, we investigated the effect of various break-in periods on short-term outcomes in patients on PD.MethodsAll patients who underwent Tenckhoff catheter implantation and initiated PD in Renji Hospital, Shanghai Jiao Tong University School of Medicine, between 1 January 2001 and 31 December 2010 were included. Patients were grouped according to the duration of their break-in period: 7 days or less (BI≤7), 8 - 14 days (BI814), and more than 14 days (BI>14). Kaplan-Meier curves and log-rank tests were used to compare short-term outcomes in the various groups.ResultsOur study enrolled 657 patients (44.5% men), of whom 344, 137, and 176 patients were in the respective break-in groups. Compared with BI>14patients, BI≤7patients had a lower estimated glomerular filtration rate (5.34 ± 1.86 mL/min/1.73 m2vs 6.55 ± 1.71 mL/min/1.73 m2, p < 0.001) and lower serum albumin (33.29 ± 5.36 g/L vs 36.64 ± 5.40 g/L, p < 0.001). The incidence of mechanical complications during the first 6 months was significantly higher in BI≤7patients than in BI>14patients (8.4% vs 1.7%, p = 0.004). However, we observed no significant differences between the three groups with respect to the prevalence of catheter dysfunction requiring surgical intervention ( p > 0.05). Logistic regression analysis showed that BI≤7[relative risk: 4.322; 95% confidence interval (CI): 1.278 to 14.608; p = 0.019] was an independent predictor of catheter dysfunction, but not of catheter dysfunction requiring surgical intervention ( p > 0.05). Catheter dysfunction [hazard ratio (HR): 20.087; 95% CI: 7.326 to 55.074; p < 0.001] and peritonitis (HR: 4.533; 95% CI: 1.748 to 11.751; p = 0.002) were risk factors for technique failure during the first 6 months, but BI≤7was not correlated with technique failure.ConclusionsPatients starting PD with a break-in period of less than 1 week might experience a minor increased risk of mechanical complications, but no major effect on technique survival.

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The efficacy and safety of a novel method of peritoneal dialysis catheter insertion from the McBurney point

Renal Replacement Therapy ◽

10.1186/s41100-020-00307-7 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Kyohei Ogawa ◽

Yukio Maruyama ◽

Nanae Matsuo ◽

Yudo Tanno ◽

Ichiro Ohkido ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Catheter Insertion ◽

Outer Side ◽

Peritoneal Dialysis Catheter ◽

Efficacy And Safety ◽

Omental Wrapping ◽

Mechanical Complications ◽

Catheter Dysfunction ◽

Novel Method ◽

Stage Renal Disease

Abstract Background Catheter dysfunction, especially omental wrapping, is a serious complication of peritoneal dialysis (PD). Although catheter implantation at a lower site was reported to prevent omental wrapping, this method could induce insufficient drainage of the PD solution and cause pain or a persistent desire to defecate, when the intraperitoneal catheter is of insufficient length or when its tip is in direct contact with the pelvic floor, respectively. The aim of this study was to assess the efficacy and safety of a novel PD catheter insertion method of approaching from the McBurney point, from the outer side of the abdomen. Methods This retrospective study included 23 patients with end-stage renal disease who were started on PD from January 2017 to July 2018 at Ashikaga Red Cross Hospital, Tochigi, Japan. Among them, 16 patients underwent a PD catheter insertion using a conventional method, whereas 7 patients underwent a novel method of approaching from the McBurney point. Infectious and mechanical complications were evaluated until August 2020. Results There were 18 men and 5 women, with a mean age of 63.1 ± 13.6 years. All patients were followed up postoperatively for a mean duration of 27.2 ± 13.4 months. No patient experienced omental wrapping, insufficient drainage of the PD solution, and pain or persistent desire to defecate in both groups. Both the incidence of infectious and mechanical complications (times per patient-year) were not statistically different between patients undergoing a conventional and a novel PD catheter insertion (0.18 vs. 0.24; p = 0.79 and 0.03 vs. 0.16; p = 0.16, respectively). Conclusions This novel method of PD catheter insertion from the McBurney point was safe, caused less discomfort, and was effective in preventing catheter dysfunction.

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The Association of Effluent CA125 with Peritoneal Dialysis Technique Failure

Peritoneal Dialysis International ◽

10.3747/pdi.2014.00016 ◽

2015 ◽

Vol 35 (7) ◽

pp. 683-690 ◽

Cited By ~ 2

Author(s):

Deirisa Lopes Barreto ◽

Tiny Hoekstra ◽

Nynke Halbesma ◽

Martijn Leegte ◽

Elisabeth W. Boeschoten ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Initial Period ◽

Academic Medical Center ◽

Cell Mass ◽

Mesothelial Cell ◽

Peritoneal Membrane ◽

Technique Survival ◽

Increased Risk ◽

Technique Failure

Background and objectivesCancer antigen 125 (CA125) reflects the mesothelial cell mass lining the peritoneal membrane in individual patients. A decline or absence of mesothelial cells can be observed with duration of peritoneal dialysis (PD) therapy. Technique failure due to peritoneal membrane malfunction becomes of greater importance after 2 years of PD therapy in comparison to the initial period. In this study, we aimed to investigate the association between effluent CA125 and technique survival in incident PD patients with a PD therapy period of at least 2 years.MethodsWithin the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD), a Dutch multicenter cohort including 2,000 incident dialysis patients, we identified all PD patients who developed technique failure after 2 years of PD therapy and randomly selected a number of them as cases in a nested case-control study. Controls were PD patients matched on follow-up time without technique failure. Cases and controls were included if they had a dialysate specimen available within 24 ± 6 months of PD therapy for retrospective CA125 determinations. Odds ratios for technique failure related to CA125 were estimated. We used a prospective cohort with incident PD patients from the Academic Medical Center–University of Amsterdam (AMC) for replication of effect estimates. In these patients, absolute risk of technique failure was estimated and related to effluent CA125 levels.ResultsA total of 38 PD patients were selected from the NECOSAD cohort. From the AMC cohort as replication cohort, 91 PD patients were included. Incidence rates of PD technique failure per 100 patient-years were 16.3 in the NECOSAD cohort and 12.9 in the AMC cohort. In both study populations CA125 levels below 12 – 14 kU/L were associated with an increased risk for technique failure. Technique survival rates in the AMC were 87% in patients with levels of CA125 above 12.1 kU/L and 65% for those with CA125 levels below this threshold after a maximum 5-year follow-up.ConclusionsPatients with high CA125 levels after at least 2 years of PD therapy tend to have better technique survival than patients with low CA125 levels. These results support the importance of effluent CA125 as a risk factor for dropout in long-term PD therapy.

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A Comparison between Intermittent Peritoneal Dialysis and Automatic Peritoneal Dialysis on Urgent Peritoneal Dialysis

American Journal of Nephrology ◽

10.1159/000477178 ◽

2017 ◽

Vol 45 (6) ◽

pp. 540-548 ◽

Cited By ~ 4

Author(s):

Chang Wang ◽

Xiao Fu ◽

Yuan Yang ◽

Jun Deng ◽

Hong-qing Zhang ◽

...

Keyword(s):

Peritoneal Dialysis ◽

First Year ◽

Mechanical Complication ◽

Chi Square ◽

Technique Survival ◽

Mechanical Complications ◽

Increased Risk ◽

Significant Difference ◽

Chi Square Test ◽

Feasible Alternative

Background: Urgent-start dialysis is a major problem for incident dialysis population. Urgent start on hemodialysis is associated with an increased risk of infectious or mechanical complications, and its mortality is equal to or higher than that of urgent start on peritoneal dialysis (PD). However, compared to patients starting PD in a planned setting, those on urgent-started PD have an increased risk of mechanical complications and lower technique survival. Methods: In this study, 101 adult incident dialysis patients (≥18 years old) who underwent Tenckhoff catheter implantation were enrolled. All of the patients were grouped according to the urgent PD mode: the intermittent PD (IPD) or automatic PD (APD) group, and patients were followed for 1 year. The paired or independent t test was used to analyze the change of laboratory variables. Pearson chi-square test was applied to compare the short outcome between the 2 groups. Results: When PD was treated for 7 days and 1 month, the APD group has the lower serum potassium and phosphorus levels than the IPD group. The incidence of catheter dysfunction was significantly lower in the APD group. The morbidity of infection associated with PD in the first year was lower in the APD group despite no significant difference existing. The technique survival and patient survival rate have no evident difference between the 2 groups. Conclusion: Compared to IPD, urgent start on APD could reduce the risk of mechanical complication, which could be considered a gentle, safe, and feasible alternative to urgent start on IPD.

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Evolution of peritoneal dialysis technique failure from 2002 to 2017 in France. RDPLF data.

Bulletin de la Dialyse à Domicile ◽

10.25796/bdd.v1i3.54 ◽

2018 ◽

Vol 1 (3) ◽

pp. 127-133

Author(s):

Benoît SCHWARTZ ◽

Fatouma TOURE

Keyword(s):

Peritoneal Dialysis ◽

Technique Survival ◽

Catheter Dysfunction ◽

Health Goal ◽

Public Data ◽

Public Health Goal ◽

End Stage ◽

Patients Experience ◽

Technique Failure ◽

Dialysis Technique

English AbstractIn France, 6 to 7 % of patients with end stage renal failure are treated by peritoneal dialysis (1). Despite the annual augmentation of treated patients, it’s still under public health goal. Peritoneal dialysis technique failure is one restraint of technique growth in France. The RDPLF collect data about technique survival and infections since 1986. Technique failure width is on restraint of PD growth. We used available data to describe trends in the different causes of technique failure to identify areas with feasible improvement to increase technical survival. Methods: This retrospective study includes public data from RDPLF over the 2002-2017 period.Results: More than 30% of treated patients experience technique failure each year and transfer to hemodialysis count for 33%. Main causes of HD transfer are inadequate dialysis, peritonitis, catheter dysfunction and fluid inadequacy. The study of technique failure causes trends shows a decreased mortality form 51% in 2002 to 38% in 2017 (p<0.05), an increase of transplantation access from 15% to 22% (p<0.05). Transfer to hemodialysis is stable 33% to 36% in the same period. The analysis au hemodialysis transfer shows a decrease of peritonitis from 22% in 2002 and 26% in 2004 to 13.6% in 2017 (p<0.05). It shows a light increase of catheter dysfunction from between 7-8% during 2002-2005 period, to 8.6-11.8% during 2013-2016 period (p>0.05). Conclusion: Technique failure causes evolved over the past fifteen years in France, there is an improvement in mortality and access to transplant, a decrease in peritonitis. Despite technique improvement and new PD solutions (Icodextrine based, biocompatible), there is still 10% of PD patients transferred each year to hemodialysis without favorable trends.

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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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MO704THE PROGNOSTIC IMPACT OF WEIGHT GAIN AFTER PERITONEAL DIALYSIS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab101.0026 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Win Hlaing Than ◽

Jack K C Ng ◽

Gordon C K Chan ◽

Winston Fung ◽

Cheuk Chun Szeto

Keyword(s):

Weight Loss ◽

Body Weight ◽

Peritoneal Dialysis ◽

Weight Gain ◽

Clinical Outcomes ◽

Patient Survival ◽

Survival Rates ◽

Overweight And Obesity ◽

Technique Survival ◽

Technique Failure

Abstract Background and Aims The prevalence of obesity has increased over the past decade in patients with End Stage Kidney Disease (ESKD). Obesity at the initiation of peritoneal dialysis (PD) was reported to adversely affect clinical outcomes. However, there are few studies on the prognostic relevance of weight gain after PD. Method We reviewed the change in body weight of 954 consecutive PD patients from the initiation of dialysis to 2 years after they remained on PD. Clinical outcomes including patient survival, technique survival, and peritonitis rate in the subsequent two years were reviewed. Results The mean age was 60.3 ± 12.2 years; 535 patients (56.1%) were men and 504 (52.8%) had diabetes. After the first 2 years on PD, the average change in body weight was 1.2± 5.1 kg; their body weight was 63.0 ± 13.3 kg; body mass index (BMI) 24.4 ± 4.4 kg/m2. The patient survival rates in the subsequent two years were 64.9%, 75.0%, and 78.9% (log rank test, p = 0.008) for patients with weight loss ≥3 kg during the first 2 years of PD weight change between -3 and +3 kg, and weight gain ≥3 kg, respectively. The corresponding technique survival rates in the subsequent two years were 93.1%, 90.1%, 91.3%, respectively (p = 0.110), and the peritonitis rates were 0.7±1.5, 0.6±1.7, and 0.6±1.1 episodes per patient-year, respectively (p = 0.3). When the actual BMI after the first 2 years of PD was categorized into underweight, normal weight, marginal overweight, overweight, and obesity groups, the patient survival rates in the subsequent two years were 77.3%, 75.2%, 73.3%, 74.3%, and 75.9%, respectively (p= 0.005), and technique survival 98.0%, 91.9%, 88.0%, 92.8%, and 81.0%, respectively (p= 0.001). After adjusting for confounding clinical factors by multivariate Cox regression models, weight gain ≥ 3kg during the first 2 years of PD was an independent protective factor for technique failure (adjusted hazard ratio [AHR] 0.049; 95% confidence interval [CI] 0.004-0.554, p = 0.015), but was an adverse predictor of patient survival (AHR 2.338, 95%CI 1.149-4.757, p = 0.019). In contrast, weight loss ≥ 3kg during the first 2 years of PD did not predict subsequent patient or technique survival. Conclusion Weight gain during the first 2 years of PD confers a significant risk of subsequent mortality but appears to be associated with a lower risk of technique failure. The mechanism of this discordant risk prediction deserves further study.

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Efficiency and safety of using a peritoneal dialysis catheter weighted with a stainless steel ballast : the Limousin experience

Bulletin de la Dialyse à Domicile ◽

10.25796/bdd.v2i4.23873 ◽

2019 ◽

Vol 2 (4) ◽

pp. 193-200

Author(s):

Bénédicte Larivière-Durgueil ◽

Rémi Boudet ◽

Marie Essig ◽

Stéphane Bouvier ◽

Ali Abdeh ◽

...

Keyword(s):

Stainless Steel ◽

Peritoneal Dialysis ◽

Infectious Complications ◽

Control Group ◽

Peritoneal Dialysis Catheter ◽

Causal Factors ◽

Catheter Migration ◽

Mechanical Complications ◽

Increased Risk ◽

One Year

Objective: To assess the recurrence of PD catheter migration after the introduction of a walnut ballast. Materials and Methods: Retrospective study from 1999 to 2014 of PD patients followed in Limousin. Were compared two groups: ballast group (patients who benefited from the establishment of stainless steel ballast at the intraperitoneal catheter extremity) with 26 patients and control group with 204 patients. The primary endpoint was the occurrence of an episode catheter’s migration after ballast’s establishment. Secondary objectives were (i) to determine the causal factors leading to the catheter weighting, (ii) to ensure the safety of the procedure on the following criteria: infectious complications, mechanicals complications, epurations criteria, and catheter’s survival. Results: More than one year after the implementation of the ballast, no recurrent migration was observed in 86.6% of cases. It wasn’t found an increased risk of infections (OR = 0.5, 95% CI [0.22, 1.13]) or mechanical complications (OR = 1.77- 95% CI [0.77, 4.05]) between the two groups. The adequation criteria were similar: KT / V total : 2.37 in the control group and 2.28 in the ballast group (p = 0.63). The survival of the ballast catheter was comparable among the two groups (p = 0.983). Three causal factors that led to the ballast were identified: automated peritoneal dialysis (APD) (OR = 0.38, 95% CI [0.16, 0.9]), the failure from the first use of the catheter (OR = 19.48, CI 95 % [7.67, 49.48]) and the incarceration of the omentum (OR = 15.84, 95% CI [5.81, 43.21]). Conclusion: The ballast used in these study appears to prevent recurrence of migration, without any impact in terms of infectious or mechanical complications, or on the dialysis criteria or on catheter’s survival. However this catheter does currently not have an EC authorization

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Predictors of Peritonitis and the Impact of Peritonitis on Clinical Outcomes of Continuous Ambulatory Peritoneal Dialysis Patients in Taiwan—10 Years’ Experience in a Single Center

Peritoneal Dialysis International ◽

10.3747/pdi.2012.00075 ◽

2014 ◽

Vol 34 (1) ◽

pp. 85-94 ◽

Cited By ~ 18

Author(s):

Yao-Peng Hsieh ◽

Chia-Chu Chang ◽

Yao-Ko Wen ◽

Ping-Fang Chiu ◽

Yu Yang

Keyword(s):

Peritoneal Dialysis ◽

Clinical Outcomes ◽

Cox Regression ◽

Drop Out ◽

Kaplan Meier ◽

Underlying Mechanisms ◽

Stage Renal Disease ◽

End Stage ◽

The Impact ◽

Technique Failure

ObjectivePeritoneal dialysis (PD) has become more prevalent as a treatment modality for end-stage renal disease, and peritonitis remains one of its most devastating complications. The aim of the present investigation was to examine the frequency and predictors of peritonitis and the impact of peritonitis on clinical outcomes.MethodsOur retrospective observational cohort study enrolled 391 patients who had been treated with continuous ambulatory PD (CAPD) for at least 90 days. Relevant demographic, biochemical, and clinical data were collected for an analysis of CAPD-associated peritonitis, technique failure, drop-out from PD, and patient mortality.ResultsThe peritonitis rate was 0.196 episodes per patient–year. Older age (>65 years) was the only identified risk factor associated with peritonitis. A multivariate Cox regression model demonstrated that technique failure occurred more often in patients experiencing peritonitis than in those free of peritonitis ( p < 0.001). Kaplan–Meier analysis revealed that the group experiencing peritonitis tended to survive longer than the group that was peritonitis-free ( p = 0.11). After multivariate adjustment, the survival advantage reached significance (hazard ratio: 0.64; 95% confidence interval: 0.46 to 0.89; p = 0.006). Compared with the peritonitis-free group, the group experiencing peritonitis also had more drop-out from PD ( p = 0.03).ConclusionsThe peritonitis rate was relatively low in the present investigation. Elderly patients were at higher risk of peritonitis episodes. Peritonitis independently predicted technique failure, in agreement with other reports. However, contrary to previous studies, all-cause mortality was better in patients experiencing peritonitis than in those free of peritonitis. The underlying mechanisms of this presumptive “peritonitis paradox” remain to be clarified.

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Time-Dependent Reasons for Peritoneal Dialysis Technique Failure and Mortality

Peritoneal Dialysis International ◽

10.3747/pdi.2008.00277 ◽

2010 ◽

Vol 30 (2) ◽

pp. 170-177 ◽

Cited By ~ 87

Author(s):

Inna Kolesnyk ◽

Friedo W. Dekker ◽

Elisabeth W. Boeschoten ◽

Raymond T. Krediet

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Peritoneal Dialysis ◽

The Netherlands ◽

Patient Survival ◽

Time Dependent ◽

First Year ◽

Technique Survival ◽

Technique Failure

BackgroundPeritoneal dialysis (PD) technique failure is high compared to hemodialysis (HD). There is a lack of data on the impact of duration of PD treatment on technique survival and on whether there is a difference in risk factors with respect to early and late failure. The aim of this study was to clarify these issues by performing a time-dependent analysis of PD technique and patient survival in a large cohort of incident PD patients.MethodsWe analyzed 709 incident PD patients participating in the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD), who started their treatment between 1997 and 2007. We compared technique and patient survival on PD in 4 periods of follow-up: within the first 3 months, and after 3 – 12 months, 12 – 24 months, and 24 – 36 months of treatment. Cox proportional hazards model was used to analyze survival on PD and technique failure. Risk factors were also identified by comparing patients that were transferred to HD with those that remained on PD. Incidence rates for every cause of dropout for each period of follow-up were calculated to establish their trends with respect to PD treatment duration.ResultsThere was a significant increase in transplantation rate after the first year of treatment. The rate of switching to HD was highest during the first 3 months and decreased afterward. One-, 2- and 3-year technique survival was 87%, 76%, and 66%, respectively. Age, diabetes, and cardiovascular disease appeared to be risk factors for death on PD or switch to HD: a 1-year increase in age was associated with a relative risk (RR) of PD failure of 1.04 [95% confidence interval (CI) 1.003 – 1.06]; for diabetes, RR of stopping PD after 3 months of treatment increased from 1.8 (95% CI 1.1 – 3) during the first year to 2.2 (95% CI 1.3 – 4) after the second year; cardiovascular disease had a major impact in the earliest period (RR 2.5, 95% CI 1.2 – 5) and had a stable influence further on (RR 2, 95% CI 1.1 – 3.5). Loss of 1 mL/minute residual glomerular filtration rate (rGFR) appeared to be a significant predictor of PD failure after 3 months of treatment, but within the first 2 years, RR was 1.1 (95% CI 1.04 – 1.25).ConclusionsIn The Netherlands, transplantation is a main reason to stop PD treatment. The incidence of PD technique failure is at its highest during the earliest months after treatment initiation and decreases later due to fewer catheter and abdominal complications as well as less influence of psychosocial factors. Risk factors for PD discontinuation are those responsible for patient survival: age, cardiovascular disease, diabetes, and rGFR.

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Improving Outcome of Capd: Twenty-Five Years’ Experience in a Single Korean Center

Peritoneal Dialysis International ◽

10.1177/089686080702700411 ◽

2007 ◽

Vol 27 (4) ◽

pp. 432-440 ◽

Cited By ~ 45

Author(s):

Seung Hyeok Han ◽

Sang Choel Lee ◽

Song Vogue Ahn ◽

Jung Eun Lee ◽

Hoon Young Choi ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Patient Survival ◽

Significant Risk ◽

Gram Positive ◽

Dialysis Adequacy ◽

Technique Survival ◽

Cardiovascular Comorbidities ◽

Significant Downward Trend ◽

Technique Failure

Background Continuous ambulatory peritoneal dialysis (CAPD) is an established treatment for end-stage renal disease (ESRD). We investigated the outcome of CAPD over a period of 25 years at our institution. Methods CAPD has been performed in 2301 patients in 25 years. After excluding patients with less than 3 months of follow-up and missing data, we evaluated 1656 patients who started peritoneal dialysis between November 1981 and December 2005. Data for sex, age, primary disease, co-morbidities, follow-up duration, cause of death, and cause of technique failure were collected. We also examined data for urea kinetic modeling (UKM), beginning in 1990, and peritonitis episodes, including causative organisms, starting in 1992. Results Compared to incident patients from 1981 – 1992, mean age and incidence of ESRD caused by diabetic nephropathy increased in patients from 1993 to 2005. Technique survival after 5 and 10 years was 71.9% and 48.1% respectively. Technique survival was significantly higher in patients who started CAPD after 1992 than in those who started before 1992. Peritonitis was the main reason for technique failure. Overall peritonitis rate was 0.38 episodes per patient-year, with a significant downward trend to 0.29 per patient-year over 10 years, corresponding to a decrease in gram-positive peritonitis. Patient survival after 5 and 10 years was 69.8% and 51.8% respectively. Patient survival improved significantly during 1992 – 2005 compared to 1981 – 1992 after adjustment for age, gender, diabetes, and cardiovascular comorbidities [hazard ratio (HR) 0.68, p < 0.01]. Subgroup analysis based on UKM revealed that dialysis adequacy did not affect patient survival. However, diabetes (HR 2.78, p < 0.001), older age (per 1 year: HR 1.06; p < 0.001), serum albumin level (per 1 g/dL: increase, HR 0.52; p < 0.05), and cardiovascular comorbidities (HR 2.32, p < 0.01) were identified as significant risk factors. Conclusion Technique survival has improved due partly to a decrease in peritonitis, which was attributed to a decrease in gram-positive peritonitis. Patient survival has also improved considering increases in aged patients and ESRD caused by diabetes. The mortality rate of CAPD is still high in older, diabetic, malnourished, and cardiovascular diseased patients. A more careful management of higher risk groups will be needed to improve the outcome of CAPD patients in the future.

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