Clinical management of patients on peritoneal dialysis in Italy: results from the ATENA study

Abstract

BackgroundIn Italy, few studies have examined the clinical management of peritoneal dialysis (PD) patients, resulting in a lack of information and awareness.MethodsA total of 378 PD patients (64.7 ± 14.3 years, 58.9% males) were enrolled across 15 centres in a 12-month retrospective and 6-month prospective study. The primary objective was to evaluate the achievement of Kidney Disease Outcomes Quality Initiative and Kidney Disease Improving Global Outcomes guidelines on recommended target values for anaemia, high blood pressure and mineral metabolism. Comorbidities, hospitalizations, treatment and quality of life were also assessed.ResultsFrequent comorbidities included hypertension (87.8%) and cardiovascular disease (39.7%). Peritonitis was the leading cause of hospitalization [12 admissions per 100 person-years (95% confidence interval 9.3–15.2)]. At 6 months, anaemia corrected by erythropoiesis-stimulating agents was observed in 30% of patients and 73% received erythropoiesis-stimulating agents. Systolic and diastolic blood pressures were recorded in 50% and 20% of patients, respectively. Sixty-four percent of echocardiograms revealed left ventricular hypertrophy and 30% of patients had vitamin D <10 ng/mL. Medication to treat intact parathyroid hormone (PTH) included calcitriol (36.3%), paricalcitol (29.2%), cholecalciferol (23.6%) and cinacalcet (21.5%). In a subgroup of patients matched for baseline PTH treated for 1 year, a significant reduction in PTH with paricalcitol (−41%; P < 0.001) but not cinacalcet (+2%; P = 0.63) was observed. Comparison of quality of life domains revealed significant differences for symptoms (P = 0.049), cognitive function (P = 0.019) and social support (P = 0.04) (baseline versus 6 months).ConclusionsHypertension and cardiovascular diseases were frequent comorbidities and peritonitis was the leading cause of hospitalization. Secondary hyperparathyroidism and anaemia were common, thus necessitating frequent monitoring of PTH, calcium, phosphorus and haemoglobin.

Mineral and bone disorders in peritoneal dialysis

“…Une série mexicaine réalisée en 2013 incluant 365 patients en dialyse péritonéale retrouve une hyperparathyroïdie chez 20 % des patients en DPCA et 32 % des patients en DPA [7]. La série italienne ATENA incluant 378 patients en dialyse péritonéale depuis au moins une année retrouve 30% d'hyperparathyroïdie secondaire [2]. L'étude réalisé à Singapour incluant 86 patients incidents en dialyse péritonéale retrouve quant à elle une hyperparathyroïdie chez 45.3% des patients à 4 mois du début de la dialyse [3].…”

“…En ce qui concerne le profil démographique des patients, notre série comporte des patients jeunes avec une moyenne d'âge de 49.18 ans, rejoignant la série mexicaine (âge moyen de 48.7 ans) [7]. L'âge moyen était de 52 ans dans la série Taiwanaise [6], 68 ans dans la série singapourienne [3] et de 64.7 ans dans la série italienne ATENA [2]. Dans notre travail l'âge n'est pas retrouvé comme étant un facteur associé à l'hyperparathyroïdie secondaire au cours de la dialyse péritonéale.…”

“…Les troubles du métabolisme minéral et osseux (TMO) sont fréquents chez les patients en dialyse et sont responsables d'une augmentation du risque de fracture, du risque cardiovasculaire et de la mortalité. En effet, de nombreuses études ont démontré que les TMO et plus précisément ceux liés à l'hyperparathyroïdie sont responsables de calcifications extra-squelettiques, notamment vasculaires et valvulaires [1][2][3], et sont incriminés dans la pathogenèse de l'hypertrophie ventriculaire gauche [4], augmentant ainsi le risque cardiovasculaire et le risque de morbi-mortalité [5].…”

Low serum parathyroid hormone is a risk factor for peritonitis episodes in incident peritoneal dialysis patients: a retrospective study

“…PD-related peritonitis remains the most major and life-threatening infection-related complication and is closely related to loss of catheter function, impairment of the peritoneal membrane, eventually discontinuation of PD therapy, conversion to hemodialysis [ 10 , 11 ]. The 2016 International Society for Peritoneal Dialysis (ISPD) guidelines recommend a benchmark of 0.5 episodes per year or one episode every 2 years [ 12 ].…”

Low Serum Parathyroid Hormone is a Risk Factor for Peritonitis Episodes in Incident Peritoneal Dialysis Patients: A Retrospective Study&nbsp;

“…PD-related peritonitis remains the most major and life-threatening infection-related complication and is closely related to loss of catheter function, impairment of the peritoneal membrane, eventually discontinuation of PD therapy, conversion to hemodialysis [10,11]. The 2016 International Society for Peritoneal Dialysis (ISPD) guidelines recommend a benchmark of 0.5 episodes per year or one episode every 2 years [12].…”