Long-Term Clinical Outcomes of Peritoneal Dialysis Patients: 9-Year Experience of a Single Center from North India

Abstract

♦ Objective: There is a paucity of published data on the outcome of maintenance peritoneal dialysis (PD) since the initiation of continuous ambulatory PD (CAPD) in India in 1991. The purpose of this study is to report long-term clinical outcomes of PD patients at a single center. ♦ Design: Retrospective study. ♦ Setting: A government-owned tertiary-care hospital in North India. ♦ Patients: Patients who were initiated on CAPD between October 2002 and June 2011, and who survived and/or had more than 6 months' follow-up on this treatment with last follow-up till December 31, 2011, were studied. ♦ Results: A total of 60 patients were included in the analysis. The mean age of the patients was 60.2 ± 9.2 years. The majority (65%) of the patients lived in rural areas. A high proportion (47%) were diabetic and 62% had ≥ 2 comorbidities. Total duration on peritoneal dialysis treatment was 1,773 patient-months (148 patient-years) with a mean duration of 29.6 ± 23 patient-months and median duration of 25 patient-months (range 6 -110 patient-months). Overall patient and technique survival at 1, 2, 3, 4 and 5 years was 77%, 53%, 25%, 15%, and 10% respectively. Patient survival of diabetics vs non-diabetics at 1, 2, 3, 4, and 5 years was 68% vs 84%, 54% vs 53%, 14% vs 34%, 11% vs 19%, and 11% vs 13%, respectively. The mortality in nondiabetics (16/32) was less than that in diabetic (18/28) patients (p = not significant). The main cause of mortality in these patients was cardiac followed by sepsis. There were 58 episodes of peritonitis. The rate of peritonitis was 1 episode per 30.6 patient-months or 0.39 episodes per patient-year. Furthermore, the total number of episodes of peritonitis and number of episodes of peritonitis per patient were higher in the non-survival group (p < 0.05). The incidence of tuberculosis (TB), herpes zoster (HZ) and hernias was 15%, 10% and 5% respectively. ♦ Conclusion: The study reports long-term outcomes of the PD patients, the majority of whom were elderly with a high burden of comorbidities. There was a high proportion of diabetics. The survival of diabetic vs non-diabetic and elderly vs non-elderly PD patients was similar in our study. The mortality in non-diabetics was less than that in diabetic patients. TB and HZ were common causes of morbidity. Peritonitis was associated with mortality in these patients.

Health-related quality of life, depression and mortality in peritoneal dialysis patients in Turkey: seven-year experience of a center

“…In this study, authors also concluded that albumin, a negative marker of inflammation, was a predictor of death in PD patients. Vikrant et al 26 also confirmed that the mortality in PD patients without diabetes was less than that in PD patients with diabetes. According to the results of this study, the main cause of mortality in PD patients was cardiac followed by sepsis.…”

“…26,27 In addition, serum albumin levels were found to be an independent predictor of mortality in recent studies in this population. 28,29 The main reason for hypoalbuminemia commonly seen in PD patients is the loss of serum albumin approximately 4 g/day through peritoneal effluent.…”

“…According to the results of this study, the main cause of mortality in PD patients was cardiac followed by sepsis. 26 However, recently, Madziarska et al 38 found that the only factor significantly associated with mortality was older age in PD patients.…”

Peritoneal Dialysis in Asia

“…Since its introduction in 1991, CAPD has become an established form of therapy in adults with ESRD in India. CAPD is gradually increasing among ESRD patients: it was 5% in 1996, 10% in 1998, 14% in 2002, and approximately 21% in 2008 [10]. It was observed that the growth of PD became more prominent in 1994 when the PD fluid was manufactured locally [3].…”

“…Explanations for why the PD rate remained low included lack of information and education among both patients and nephrologists and an overwhelming fear of developing encapsulating peritoneal sclerosis [9]. However, with recent new multidisciplinary approaches to tackle this problem of encapsulating peritoneal sclerosis in Japan and more interest from Japanese nephrologists in putting patients on PD, it is likely that the trend of PD penetration in Japan will increase [10]. …”