scholarly journals Continuous Ambulatory Peritoneal Dialysis in Limpopo Province, South Africa: Predictors of Patient and Technique Survival

2014 ◽  
Vol 34 (5) ◽  
pp. 518-525 ◽  
Author(s):  
Ramon A. Tamayo Isla ◽  
Darlington Mapiye ◽  
Charles R. Swanepoel ◽  
Nadiya Rozumyk ◽  
Jerome E. Hubahib ◽  
...  
Keyword(s):  
South Africa ◽  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Tap Water ◽  
Average Distance ◽  
Limpopo Province ◽  
Composite Outcome ◽  
Technique Survival ◽  
At Home

Introduction and aimContinuous ambulatory peritoneal dialysis (CAPD) is not a frequently used modality of dialysis in many parts of Africa due to several socio-economic factors. Available studies from Africa have shown a strong association between outcome and socio-demographic variables. We sought to assess the outcome of patients treated with CAPD in Limpopo, South Africa.MethodsThis was a retrospective study of 152 patients treated with CAPD at the Polokwane Kidney and Dialysis Centre (PKDC) from 2007 to 2012. We collected relevant demographic and biochemical data for all patients included in the study. A composite outcome of death while still on peritoneal dialysis (PD) or CAPD technique failure from any cause requiring a change of modality to hemodialysis (HD) was selected. The peritonitis rate and causes of peritonitis were assessed from 2008 when all related data could be obtained.ResultsThere were 52% males in the study and the average age of the patients was 36.8 ± 11.4 years. Unemployment rate was high (71.1%), 41.1% had tap water at home, the average distance travelled to the dialysis center was 122.9 ± 78.2 kilometres and half the patients had a total income less than USD ($)180 per month. Level of education, having electricity at home, having tap water at home, body mass index (BMI), serum albumin and hemoglobin were significantly different between those reaching the composite outcome and those not reaching it ( p < 0.05). The overall peritonitis rate was 0.82/year with 1-year, 2-year and 5-year survival found to be 86.7%, 78.7% and 65.3% (patient survival) and 83.3%, 71.7% and 62.1% (technique survival). Predictors of the composite outcome were BMI ( p = 0.011), serum albumin ( p = 0.030), hemoglobin ( p = 0.002) and more than 1 episode of peritonitis ( p = 0.038).ConclusionTreatment of anemia and malnutrition as well as training and re-training of CAPD patients and staff to prevent recurrence of peritonitis can have positive impacts on CAPD outcomes in this population.

Dialysis at Home in the West of Scotland: A Comparison of Hemodialysis and Continuous Ambulatory Peritoneal Dialysis in Age and Sex-Matched Controls

1992 ◽  
Vol 12 (4) ◽  
pp. 365-368 ◽  
Author(s):  
Alexander C. Grant ◽  
R. Stuart C. Rodger ◽  
Catherine A. Howie ◽  
Brian J.R. Junor ◽  
J. Douglas Briggs ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Hemodialysis Patients ◽  
Left Ventricular ◽  
The West ◽  
Home Dialysis ◽  
Technique Survival ◽  
Significant Difference ◽  
Age And Sex ◽  
At Home

Objective To audit the outcome of patients treated at home by hemodialysis and continuous ambulatory peritoneal dialysis (CAPD). Design Retrospective comparison of nondiabetic hemodialysis patients with age and sex-matched nondiabetic patients treated by CAPD. Setting Renal Units, Stobhill General Hospital and Western Infirmary, Glasgow, providing the home dialysis service for the West of Scotland. Patients Between 1982 and 1988, 139 hemodialysis patients starting treatment at home, compared with 139 matched patients starting CAPD over the same time period. Main Outcome Measures Patient characteristics and cardiovascular risk factors at the start of home treatment. Patient and technique survival with both forms of dialysis. Results Patients selected for home hemodialysis were less likely to be smokers (p<0.02) and to have electrocardiographic evidence of ischemia or left ventricular hypertrophy (p<0.05) than patients treated by CAPD. Patient survival and technique survival (excluding death and renal transplantation) at 3 years were 93.8% versus 86.2% (p<0.05) and 94.2% versus 80.8% (p<0.04) for hemodialysis and CAPD, respectively. Cardiovascular events were responsible for the majority of deaths in both groups, but there was a greater proportion of deaths from other causes in patients treated by CAPD. There was no significant difference in the transplantation rate between the two treatment groups. Conclusions Home dialysis is an effective method of renal replacement treatment for patients with end-stage renal disease. The results of hemodialysis are superior to CAPD, but this may be partly due to selection bias.

scholarly journals Serum albumin in patients on continuous ambulatory peritoneal dialysis--predictors and correlations with outcomes.

1993 ◽  
Vol 3 (8) ◽  
pp. 1501-1507 ◽  
Author(s):  
P G Blake ◽  
G Flowerdew ◽  
R M Blake ◽  
D G Oreopoulos
Keyword(s):  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Morbidity And Mortality ◽  
Stepwise Multiple Regression ◽  
Technique Survival ◽  
Patient Morbidity ◽  
Technique Failure

Serum albumin (SA) is a powerful predictor of patient morbidity and mortality in hemodialysis, but data are limited for continuous ambulatory peritoneal dialysis (CAPD). SA was monitored in 76 new CAPD patients over 222 6-month periods and mean SA was correlated with morbidity and mortality during those periods. The influence of initial SA on duration of technique survival was also investigated. To determine which factors best predict SA, correlations with patient demographics and with 6-month measurements of dialytic dose, protein intake, and peritoneal transport were sought. Mean SA overall was 34.1 +/- 3.3 g/L, and mean initial SA was 33.4 +/- 3.1 g/L. Mean SA was lower in diabetics and in those aged 65 or over. Mean SA tended to increase during the first year on CAPD, and this increase was maintained, except in patients aged 65 or over, where it tended to revert to initial values. SA correlated with hospital days (r = -0.20; P < 0.005), fatigue index (r = -0.20; P < 0.005), nerve conduction (P < 0.001), and a variety of laboratory values, and lower SA was associated with technique failure (P < 0.03) and death (P < 0.07). Initial, as well as ongoing, SA was predictive of technique failure (P < 0.05) and Cox proportional hazards regression showed that this predictive power was independent of age, sex, diabetes, and other factors (P = 0.05). The strongest predictors of low SA by stepwise multiple regression were diabetes, a higher dialysate-to-plasma creatinine equilibration ratio, older age, lower body weight, and shorter time on CAPD.(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals Impact of Dialysis Adequacy on the Mortality and Morbidity of Anuric Chinese Patients Receiving Continuous Ambulatory Peritoneal Dialysis

2001 ◽  
Vol 12 (2) ◽  
pp. 355-360 ◽  
Author(s):  
CHEUK-CHUN SZETO ◽  
TERESA YUK-HWA WONG ◽  
KAI-MING CHOW ◽  
CHI-BON LEUNG ◽  
MAN-CHING LAW ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Patient Survival ◽  
Residual Renal Function ◽  
The Body ◽  
Chinese Patients ◽  
Dialysis Adequacy ◽  
Technique Survival

Abstract. Dialysis adequacy has a major impact on the outcome of continuous ambulatory peritoneal dialysis (CAPD) patients. However, most studies on peritoneal dialysis adequacy have focused on patients with significant residual renal function. The present study examined the effect of dialysis adequacy on anuric CAPD patients. A single-center prospective observational study on 140 anuric CAPD patients was performed. These patients were followed for 22.0 ± 11.9 mo. Dialysis adequacy and nutritional indices, including Kt/V, creatinine clearance (CCr), protein equivalent nitrogen appearance, percentage of lean body mass, and serum albumin level were monitored. Clinical outcomes included actuarial patient survival, technique survival, and duration of hospitalization. In the study population, 64 were male, 36 (25.7%) were diabetic, and 59 (42.1%) were treated with 6 L exchanges per day. The body weight was 59.2 ± 10.2 kg. Average Kt/V was 1.72 ± 0.31, and CCr was 43.7 ± 11.5 L/wk per 1.73m2. Two-yr patient survival was 68.8%, and technique survival was 61.4%. Multivariate analysis showed that DM, duration of dialysis before enrollment, serum albumin, and index of dialysis adequacy (Kt/V or CCr) were independent factors of both patient survival and technique survival. It was estimated that for two patients who differed only in weekly Kt/V, a 0.1 higher value was associated with a 6% decrease in the RR of death (P < 0.05; 95% confidence interval, 0.92 to 0.99). Serum albumin and CCr were the only independent factors that predicted hospitalization. It was found that even when there is no residual renal function, higher dialysis dosage is associated with better actuarial patient survival, better technique survival, and shorter hospitalization. Dialysis adequacy has a significant impact on the clinical outcome of CAPD patients, and the beneficial effect is preserved in anuric patients as well as in an ethnic group that has a low overall mortality.

Adverse Prognostic Indicators in Continuous Ambulatory Peritoneal Dialysis Patients without Obvious Vascular or Nutritional Comorbidities

2003 ◽  
Vol 23 (2_suppl) ◽  
pp. 109-115 ◽  
Author(s):  
Ping-Nam Wong ◽  
Siu-Ka Mak ◽  
Kin-Yee Lo ◽  
Gensy M.W. Tong ◽  
Yuk Wong ◽  
...  
Keyword(s):  
Body Weight ◽  
Peritoneal Dialysis ◽  
Body Size ◽  
Serum Albumin ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Patient Survival ◽  
Vascular Events ◽  
Dialysis Adequacy ◽  
Technique Survival ◽  
Risk Of Death

Objectives Factors that predict the occurrence of vascular events and poor patient survival in continuous ambulatory peritoneal dialysis (CAPD) patients have not been clearly defined. Previous studies have focused on nonselective CAPD patients, in whom pre-existing comorbidity or poor health might complicate interpretation of the significance of individual factors. The present study was conducted with CAPD patients without severe vascular and nutritional comorbidity. Patients and Methods This single-center, prospective, observational study was conducted with 66 prevalent CAPD patients without co-existing severe vascular or nutritional problems. The patients were enrolled in January 1999. We monitored baseline demographic data and clinical and laboratory characteristics including average clinic blood pressure (BP), hemoglobin (Hb), serum albumin, intact parathyroid hormone (iPTH), serum cholesterol, triglycerides, dialysate-to-plasma (D/P) creatinine, dialysis adequacy [Kt/V and creatinine clearance (CCr)], and protein equivalent of nitrogen appearance. We followed the patients for 3 years. Outcome measures were actuarial patient survival, time to occurrence of cerebrovascular accident (CVA) and acute myocardial infarction (AMI), technique survival, and hospitalization rate. Results Mean age of the patients was 56.7 ± 10.3 years. Mean duration on CAPD at the time of enrollment was 36.4 ± 21.7 months. Nineteen of the patients (28.8%) had diabetes. Most of the patients [ n = 55 (83.3%)] were using three 2-L exchanges daily. Mean body weight was 56.3 ± 12.2 kg. Mean total weekly Kt/V was 1.91 ± 0.47, and mean total weekly CCr was 75.3 ± 30.6 L/1.73 m2. Actuarial patient survival was 96.9% at 1 year, 90.5% at 2 years, and 75.3% at 3 years. Overall technique survival was 96.9% at 1 year, 95.1% at 2 years, and 89.1% at 3 years. Multivariate analysis showed that age, diabetes mellitus (DM), and body size (weight or surface area) were independent predictors of patient survival. We estimated that a 1-kg increase in body weight was associated with a 6% increase in the relative risk of death ( p = 0.015; 95% confidence interval: 1.013 to 1.126). Patients with a body weight of 60 kg or less showed a significantly better 3-year survival as compared with patients with body weight greater than 60 kg (88.1% vs 58.3%, p = 0.0042). No significant predictors were identified for technique failure or occurrence of a major vascular event. High BP and DM were independent predictors for hospitalization. Dialysis adequacy indices and serum albumin showed no significant effect on any outcome measure. Conclusions Our study showed that, in addition to age and DM, body size could also be a significant factor affecting survival of CAPD patients. However, the underlying causative mechanisms remain unclear and require further study.

The Effect of Serum Albumin at the Start of Continuous Ambulatory Peritoneal Dialysis Treatment on Patient Survival

1994 ◽  
Vol 14 (2) ◽  
pp. 121-126 ◽  
Author(s):  
Dirk G. Struijk ◽  
Raymond T. Krediet ◽  
Gerardus C.M. Koomen ◽  
Elisabeth W. Boeschoten ◽  
Lambertus Arisz
Keyword(s):  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Patient Survival ◽  
Cox Model ◽  
Medical Center ◽  
Systemic Disease ◽  
Ideal Body Weight ◽  
Plasma Urea ◽  
Lower Survival Rate

Objective To analyze the effect of serum albumin using immunoturbidimetry, demographic, biochemical, and kinetic factors on survival of continuous ambulatory peritoneal dialysis (CAPD) patients. Design A review of prospectively collected data in a 2-year follow-up study of peritoneal transport kinetics. Setting University medical center. Participants Sixty-one patients, evaluated within 3 months after the start of CAPD. Main Outcome Measures Covariables used in the survival analysis were plasma urea, and creatinine, albumin, hemoglobin, mass transfer area coefficient of creatinine, peritoneal albumin clearance, 4-hour peritoneal albumin loss, net ultrafiltration, age, blood pressure, body mass index, difference between actual and ideal body weight, and presence or absence of systemicdisease. Results Overall survival was 64% at 2 years. Median serum albumin was 30.9 g/L, range 18.1 -43.9 g/L. Patients with a serum albumin below the median had a lower survival rate than those higher than the median (2-year survival 49% vs 79%, p = 0.01). Using the Cox model, survival was related to systemic disease (p = 0.004), age (p = 0.02), hemoglobin (p = 0.03), and serum albumin (p = 0.1). Conclusions The results confirm the strength of serum albumin as predictor of survival. However, in this study serum albumin merely reflected the presence of a systemic disease, which was the most important risk factor for patient survival.

Continuous Ambulatory Peritoneal Dialysis in South Africa -A Four-Year Experience

1984 ◽  
Vol 4 (2) ◽  
pp. 78-81 ◽  
Author(s):  
I. Parsoo ◽  
Y.K. Seedat ◽  
S. Naicker ◽  
J.C. Kallmeyer
Keyword(s):  
South Africa ◽  
Developing Countries ◽  
Renal Failure ◽  
Peritoneal Dialysis ◽  
Renal Transplantation ◽  
Chronic Renal Failure ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Minority Groups ◽  
Alternative Therapy ◽  
Major Complication

This study describes our experience with continuous ambulatory peritoneal dialysis (CAPD) over a four year period, during which 88 patients were offered CAPD. It compares and contrasts the response to CAPD among four racial groups in Natal viz asiatics, blacks, coloureds and whites. Peritonitis -the major complication, occurred with an overall incidence of one episode every 4.41 patient months. CAPD remains a useful alternative therapy in developing countries where a high percentage of patients with chronic renal failure would be denied a chronic renal failure program because of lack of expertise in hemodialysis and/or renal transplantation, or limited financial resources. Continuous ambulatory peritoneal dialysis (CAPD) was first described by Moncrief and Popovich (1) and, since its modification by Oreopoulos and his group (2), this technique has gained world wide usage. South Africa, like many developing countries has a high incidence of end-stage renal disease (ESRD) but because of lack of resources and economical problems, few patients with ESRD can be treated by dialysis or renal transplantation. CAPD affords a relatively simple and inexpensive form of therapy for these patients. At the present time about 200 patients are on CAPD in South Africa. Natal, the smallest of four provinces in South Africa, has a population of about five million, the majority being blacks. The minority groups include whites, asiatics and coloureds. There is only one chronic dialysis centre in Natal; situated in Durban, it serves the entire province including parts of the Transkei. This paper describes a four-year experience with CAPD in this mixed population and discusses problems unique to this situation.

National Comparisons: Optimal Peritoneal Dialysis Outcomes among Japanese Patients

1999 ◽  
Vol 19 (3_suppl) ◽  
pp. 9-16 ◽  
Author(s):  
Yoshindo Kawaguchi
Keyword(s):  
Peritoneal Dialysis ◽  
Positive Selection ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Therapeutic Intervention ◽  
Scoring System ◽  
Japanese Patients ◽  
Current Status ◽  
Technique Survival ◽  
Ultrafiltration Failure ◽  
Dialysis Outcomes

This paper describes the current status of chronic dialysis in Japan and the guidelines used to initiate dialysis (scoring system), and reports the outcome of continuous ambulatory peritoneal dialysis (CAPD), focusing upon our center's experience. Fifty percent of CAPD technique survival was 6.9 ± 1.3 years among those patients classified as “positive selection.” The major causes of withdrawal from CAPD were ultrafiltration failure, the patients’ inability to continue on CAPD by themselves, and peritonitis. The clinical issues that most concern nephrologists in CAPD management are prevention and management of ultrafiltration failure, prevention/therapeutic intervention in encapsulating peritoneal sclerosis, catheter-related infections, and prevention of underdialysis.

Subclinical Peripheral Artery Disease in Patients Undergoing Peritoneal Dialysis: Risk Factors and Outcome

2009 ◽  
Vol 29 (1) ◽  
pp. 64-71 ◽  
Author(s):  
Jiung-Hsiun Liu ◽  
Hsin-Hung Lin ◽  
Ya-Fei Yang ◽  
Yao-Lung Liu ◽  
Huey-Liang Kuo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Peripheral Artery Disease ◽  
Serum Triglyceride ◽  
Advanced Age ◽  
Peripheral Artery ◽  
Technique Survival ◽  
Artery Disease ◽  
Highly Correlated

Background Peripheral artery disease (PAD) is highly prevalent among patients in end-stage renal disease. The ankle–brachial index (ABI) is believed to be highly correlated with the subclinical PAD of lower extremities but little is known about the associated risk factors and outcome for PAD and ABI in patients on peritoneal dialysis (PD). Methods We performed a cohort study of 153 patients from a single center receiving stable PD for more than 3 months. These patients were screened for subclinical PAD using the ABI measurement. The ABI was measured and a ratio of <0.9 was considered abnormal. Clinical outcomes included actuarial patient and technique survival in this study. Results 30 patients were classified into a subclinical PAD group. The prevalence of PAD (subclinical and overt) in our PD center was 19.61% (30/153). Advanced age, preexisting diabetes, preexisting cardiovascular and/or cerebrovascular disease (CVD), lower renal Kt/V urea, lower renal creatinine clearance (WCrCl), lower serum albumin level, and higher serum triglyceride level were risk factors for PAD in our PD center. Bivariate analysis showed that ABI was positively correlated with residual renal Kt/V urea and WCrCl, but was not correlated with peritoneal Kt/V urea and WCrCl. Patient and technique survival rates were significantly lower in the low ABI group than in the normal ABI group. Conclusions ABI is highly correlated with advanced age, preexisting diabetes, preexisting CVD, serum albumin, serum triglyceride, and residual renal clearance in PD patients. Also, lower ABI is independently associated with a high risk of patient mortality and PD technique failure.

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