Long-term clinical outcomes of peritoneal dialysis patients: 9-year experience of a single centre in Turkey

Abstract

The prevalence of end-stage renal disease (ESRD) is increasing in the world [1,2]. Peritoneal dialysis (PD) has been an alternative treatment to hemodialysis (HD) for patients with ESRD since 1976 [3,4]. PD is a homebased treatment with many advantages; preservation of residual renal function (RRF), hemodynamic stability, better quality of life and cost savings [5][6][7][8]. Survival rates with PD are better than those with HD after 3 years from initiation [5,8,9]. Despite the advantages of PD in quality of life compared with haemodialysis, the prevalence of PD decreases gradually [10,11]. In our country too, total number of PD patients is gradually decreasing over the years [12].Prevalent PD patients in our country as of the end of 2007 were 5307 patients and this number decreased to 3346 at the end of 2017, according to the Turkish Kidney Registry System Reports [12,13]. The long-term benefits of PD are still controversial [5]. Therefore, this study aimed to report a single-center experience and long-term clinical outcomes of PD over a 9-year period. Materials and methods ParticipantsThis study was approved by Baskent University Institutional Review Board (Project no: KA19/196) and supported by Başkent University Research Fund. This was a retrospective cohort study. All patients who were initiated on PD at Başkent University Adana Dr. Turgut Noyan Training and Research Hospital, in Turkey, from January 2011 to May 2019, were included. The patients who were younger than 18 years and the patients with a PD history of less than 3 months were excluded from our analysis. The follow-up of the patients was reviewed until death, renal transplantation, transferred to HD or the end of the study in May 2019. Clinical proceduresA double-cuffed Curl Tenckhoff catheter (ArgyleTM Peritoneal Dialysis Catheter Kit, Curl Catch, 2 Cuff, 62 cm) was inserted in all patients in our centre using the laparoscopy technique by general surgeons. After a break period, patients and their caregivers underwent a standard Background/aim: The aim of this study was to evaluate the clinical outcomes and identify the predictors of mortality in peritoneal dialysis patients. Materials and methods:Medical records of all incident peritoneal dialysis (PD) patients followed up between January 2011 and May 2019 were reviewed retrospectively. All patients were followed up until death, renal transplantation, transfer to haemodialysis or the end of the study.Results: A total of 242 patients were included in the study. The incidence of peritonitis was 0.18 (ranging from 0 to 14.9) episodes per patient year. Death occurred in 28% (n: 68) of cases. Age, diabetes mellitus, malignancy and refractory heart failure were independent risk factors for all-cause mortality according to multivariate analysis. The presence of comorbid disease and diabetes mellitus and patients aged > 65 years were associated with increased risk of mortality and decreased patient survival. Peritonitis history was associated with increased risk of mortality. Between peritonitis and perito...

Comparison of clinical features and outcomes in peritoneal dialysis-associated peritonitis patients with and without diabetes: A multicenter retrospective cohort study

“…The discrepancy between our study and previous studies may be explained by distinct patient characteristics and different covariates included in the Cox proportional hazards model. Similar to the previous study, we also did not find diabetes to be a risk factor for technical failure, further affirming that diabetes should not be considered a hurdle for instituting peritoneal dialysis[ 11 - 13 ].…”

“…The effect of DM on long-term prognostic outcomes of PDAP is controversial. A previous study found that DM is a risk factor for all-cause death[ 13 ]. Additionally, the study by Tsai et al[ 14 ] in a single Taiwan center also found a positive relation between DM and PDAP treatment failure, which was defined as death or catheter removal.…”

“…However, only few studies have analyzed the long-term prognostic outcomes of PDAP in patients with DM, often with discrepant results. Some studies concluded that DM was not a risk factor for death or technical failure[ 11 , 12 ] while others found DM to be a risk factor for all-cause death[ 13 ], yet again some researchers like Tsai et al[ 14 ] found DM to be a significant risk factor for a combined outcome of death and catheter removal. More importantly, as far as we know, the profile of clinical symptoms, distribution of pathogenic organisms, and response of PDAP to medical management in the subset of ESRD patients with DM has not been reported previously.…”

Effect of Serum Albumin Changes on Mortality in Patients with Peritoneal Dialysis: A Joint Modeling Approach and Personalized Dynamic Risk Predictions

“…Interpreting unadjusted survival rates might be misleading because patients' survival might decrease dramatically with comorbidities and other risk factors (e.g., age at PD initiation, nutritional status, clinical and biochemical outcomes such as hemoglobin level, and white blood cell count). For example, Turkey's five-year survival rates were reported as 36.8% and 79.8% in diabetic and nondiabetic subgroups, respectively, which was found to be significantly different [4].…”

“…According to Li et al [3], peritoneal dialysis use was estimated between 4% and 71.9%, and 5-year survival between 34% and 64% in different countries globally. In Turkey, Sipahioglu et al [2] estimated 5-year survival rates as 68.8%, and Tekkarismaz and Torun [4] estimated them as 65% in adults, which was higher than other regions reported by Li et al [3]. Interpreting unadjusted survival rates might be misleading because patients' survival might decrease dramatically with comorbidities and other risk factors (e.g., age at PD initiation, nutritional status, clinical and biochemical outcomes such as hemoglobin level, and white blood cell count).…”