Old and New Perspectives on Peritoneal Dialysis in Italy Emerging from the Peritoneal Dialysis Study Group Census

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p>To understand how peritoneal dialysis (PD) was being used in Italy in 2005 and 2008, a census of all centers was carried out.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>In 2005 and 2008, data were collected from, respectively, 222 and 223 centers, with respect to 4432 and 4094 prevalent patients.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In the two periods, the PD incidence remained stable (24.3% vs 22.9%), varying from center to center. Continuous ambulatory PD (CAPD) was the main initial method (55%), but APD was more widespread among prevalent patients (53%). Among patients returning to dialysis from transplantation (Tx), PD was used in 10%. The use of incremental CAPD increased significantly from 2005 to 2008, in terms both of the number of centers (27.0% vs 40.9%) and of patients (13.6% vs 25.7%). Late referrals remained stable at 28%, with less use of PD. The overall drop-out rate (episodes/100 patient–years) remained unchanged (31.0 vs 32.8), with 13.1 and 12.9 being the result of death, and 11.8 and 12.4 being the result of a switch to hemodialysis, mainly after peritonitis. A dialysis partner was required by 21.8% of the PD patients. The incidence of peritonitis was 1 episode in 36.5 and 41.1 patient–months, with negative cultures occurring in 17.1% of cases in both periods. The incidence of encapsulating peritoneal sclerosis (episodes/100 patient–years) was 0.70, representing 1.26% of patients treated. The catheter types used and the sites and methods of insertion varied widely from center to center.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>These censuses confirm the good results of PD in Italy, and provide insight into little-known aspects such as the use of incremental PD, the presence of a dialysis partner, and the incidence of encapsulating peritoneal sclerosis.</jats:p></jats:sec>

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

“…The Italian Study Group of Peritoneal Dialysis reported an incidence of PD of ∼20% and a prevalence of 15% [ 5 , 6 ]. This discrepancy in the use of RRT methods is caused by several factors and, in Italy, PD continues to be used heterogeneously [ 4 ].…”

“…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 ].…”

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

“…Although hemodialysis (HD) still represents the leading RRT, peritoneal dialysis (PD) procedure is utilized in more than 150,000 patients world-wide with a prevalence in Europe of 16% and in USA of 8% [ 2 ]. Recent data from the Italian Study Group of Peritoneal Dialysis have reported an incidence of this dialysis modality of approximately 20% with a prevalence of 15% [ 3 , 4 ].…”

Continuous ambulatory peritoneal dialysis: perspectives on patient selection in low- to middle-income countries

“…Several LMICs have high peritonitis rates often leading to poor outcome ( Figure 1A and B). 41,[53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71] Youmbissi et al 71 concluded that high peritonitis rates will continue to limit the extension of CAPD in the developing world, particularly in tropical Africa, following their experience in Cameroon which showed that there were 40 episodes of peritonitis over 18 patient years, representing 2.2 episodes of peritonitis every patient year. However, other centers have not increased the use of CAPD despite seeing a reduction in peritonitis rates over time due to other factors.…”