How has peritoneal dialysis changed over the last 30 years: experience of the Verona dialysis center

Abstract

BackgroundThe last decade has witnessed considerable improvement in dialysis technology and changes in clinical management of patients in peritoneal dialysis (PD) with a significant impact on long term clinical outcomes. However, the identification of factors involved in this process is still not complete.MethodsTherefore, to assess this objective, we retrospectively analyzed clinical records of 260 adult patients who started PD treatment from 1983 to 2012 in our renal unit. For the analysis, we divided them into three groups according to the time of starting dialysis: GROUP A (n: 62, 1983–1992), GROUP B (n: 66, 1993–2002) and GROUP C (n: 132, 2003 to 2012).ResultsStatistical analysis revealed that patients included in the GROUP C showed a reduction in mean patients’ age (p = 0.03), smoking habit (p = 0.001), mean systolic blood pressure (p < 0.0001) and an increment in hemoglobin levels (p < 0.0001) and residual diuresis (p = 0.016) compared to the other two study groups. Additionally, patients included in GROUP C, mainly treated with automated peritoneal dialysis, showed a reduced risk of all-causes mortality and a decreased risk to develop acute myocardial infarction and cerebrovascular disease. Patients’ age, diabetes mellitus and smoking habit were all positively associated with a significant increased risk of mortality in our PD patients, while serum albumin levels and residual diuresis were negatively correlated.ConclusionsTherefore, the present study, revealed that in the last decade there has been a growth of our PD program with a concomitant modification of our patients’ characteristics. These changes, together with the evident technical advances, have caused a significant improvement of patients’ survival and a decrement of the rate of hospitalization. Moreover, it reveals that our pre-dialysis care, modifying the above-mentioned factors, has been a major cause of these clinical improvements.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-015-0051-3) contains supplementary material, which is available to authorized users.

Survival and time-to-transplantation of peritoneal dialysis versus hemodialysis for end-stage renal disease patients: competing-risks regression model in a single Italian center experience

“…Conversely, PD initiation in the United States has traditionally been low, never exceeding 15 to 16% of incident or prevalent maintenance dialysis patients [ 1 ]. In Italy, recent data from the Italian Study Group of Peritoneal Dialysis have reported an incidence of PD modality of approximately 20% with a prevalence of 15% [ 3 ]. The underuse of PD does not seem justified in terms of safety and effectiveness; it could be explained, instead, by a complex set of clinical, organizational, economic as well as patient-related factors favoring HD use [ 4 ].…”

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

“…Several observational studies in Italy have examined the clinical management of HD patients, although few have examined the clinical outcome and management of PD patients [ 6 , 9 , 10 ].…”

“…Few epidemiological studies have assessed the clinical management of patients on PD in Italy [ 6 , 9 , 10 ]. These were single-centre studies [ 10 ] or lacked data on therapeutic management, comorbid diseases or outcome measures [ 6 , 9 ] or were performed 10–20 years ago [ 9 ].…”

“…Few epidemiological studies have assessed the clinical management of patients on PD in Italy [ 6 , 9 , 10 ]. These were single-centre studies [ 10 ] or lacked data on therapeutic management, comorbid diseases or outcome measures [ 6 , 9 ] or were performed 10–20 years ago [ 9 ]. Mortality from cardiovascular disease (CVD) is higher in patients with chronic kidney disease (CKD) compared with the general population [ 11 ], but, unlike patients on HD, ESRD patients receiving PD present lower mortality rates during the first 2 years of treatment; rates then rise over subsequent years [ 8 , 12–14 ].…”

A prime determinant in selecting dialysis modality: peritoneal dialysis patient survival

“…A cooperative study of Spanish PD registries showed that annual mortality was gradually decreasing, despite significant regional differences [ 12 ]. In addition, one report showed that Italian PD patient survival significantly improved over 30 years [ 13 ].…”