Effect of Glomerular Filtration Rate at Peritoneal Dialysis Initiation on Clinical Outcomes: A Retrospective Cohort Study

Background: The optimal time for peritoneal dialysis (PD) initiation remains controversial. Objective: To assess the correlation between estimated glomerular filtration rate (eGFR) at PD initiation and clinical outcomes. The primary outcome was the patient’s survival, and the secondary outcomes were PD-related complications and hospitalization. Materials and Methods: The patients that underwent PD between January 1, 2013 and December 31, 2017 were enrolled in the present retrospective study. Demographic, laboratories, PD data, and adequacy of PD were collected from the medical records. Patients were categorized according to their eGFR at the initiation of PD into four groups including: less than 3, 3 to 5.9, 6 to 9.9, and 10 mL/minute/1.73 m² or more for assessing the association with the clinical outcomes. Results: Data from 532 PD patients were analyzed. The mean eGFR at the initiation of PD was 5.07±2.56 mL/minute/1.73 m², residual urine 545.75±481.07 mL/day. One hundred sixty-nine (31.7%) patients died during follow-up period. Kaplan Meier survival analyses showed that patients who started PD at eGFR less than 3 and 3 to 5.9 mL/minute/1.73 m² had a lower mortality risk than the other groups (p<0.001). In multivariate analyses, age, coronary artery disease, and hospitalization were independent factors of death but the level of eGFR at the beginning of PD did not affect the outcome. There was no significant difference among the four groups in hospitalization (p=0.83) and peritonitis (p=0.61). Conclusion: Initiation of PD at extremely-low and low eGFR were associated with better survival outcomes than the higher groups but were similar in the results of hospitalization and peritonitis. Keywords: peritoneal dialysis, glomerular filtration rate, survival rate, peritonitis

Peritoneal Dialysis

In peritoneal dialysis (PD), the peritoneum serves as a biological dialyzing membrane. The endothelium of the vast capillary network perfusing the peritoneum functions as a semipermeable membrane and allows bidirectional solute and water transfer between the intravascular space and dialysate fluid dwelling in the peritoneal cavity. PD is a renal replacement strategy for patients presenting with end-stage renal disease. It can also be offered for ultrafiltration in patients with diuretic-resistant fluid overload even in those without advanced renal failure. PD can also be used for patients with acute kidney injury, although in the developed world this occurs rarely compared to the use of extracorporeal therapies. This review contains 9 videos, 8 figures, 4 tables, and 73 references. Keywords: peritoneal dialysis, peritoneal cavity, catheter, dialysis fluid, ultrafiltration, tunnel infection, osmotic pressure, renal failure

Peritoneal Dialysis

In peritoneal dialysis (PD), the peritoneum serves as a biological dialyzing membrane. The endothelium of the vast capillary network perfusing the peritoneum functions as a semipermeable membrane and allows bidirectional solute and water transfer between the intravascular space and dialysate fluid dwelling in the peritoneal cavity. PD is a renal replacement strategy for patients presenting with end-stage renal disease. It can also be offered for ultrafiltration in patients with diuretic-resistant fluid overload even in those without advanced renal failure. PD can also be used for patients with acute kidney injury, although in the developed world this occurs rarely compared to the use of extracorporeal therapies. This review contains 9 videos, 8 figures, 4 tables, and 73 references. Keywords: peritoneal dialysis, peritoneal cavity, catheter, dialysis fluid, ultrafiltration, tunnel infection, osmotic pressure, renal failure

Peritoneal Dialysis

In peritoneal dialysis (PD), the peritoneum serves as a biological dialyzing membrane. The endothelium of the vast capillary network perfusing the peritoneum functions as a semipermeable membrane and allows bidirectional solute and water transfer between the intravascular space and dialysate fluid dwelling in the peritoneal cavity. PD is a renal replacement strategy for patients presenting with end-stage renal disease. It can also be offered for ultrafiltration in patients with diuretic-resistant fluid overload even in those without advanced renal failure. PD can also be used for patients with acute kidney injury, although in the developed world this occurs rarely compared to the use of extracorporeal therapies. This review contains 9 videos, 8 figures, 4 tables, and 73 references. Keywords: peritoneal dialysis, peritoneal cavity, catheter, dialysis fluid, ultrafiltration, tunnel infection, osmotic pressure, renal failure