Peritoneal dialysis in the US: Evaluation of outcomes in contemporary cohorts

Abstract

Secular trends in dialysis therapy delivery require a frequent re-examination of outcomes in patients on renal replacement modalities. We examined four large cohorts of patients initiating peritoneal dialysis (PD) in 2000-2003 (total of >40 000 patients) to ascertain trends in patient outcomes, technique success, and predictors of both parameters of interest. Age, end-stage renal disease vintage, and diabetes were clear predictors of patient survival. Technique success was higher in patients on automated PD than in patients on continuous ambulatory PD. Center size was a powerful predictor of technique success. We conclude that the current state of PD in the United States is characterized by improving patient outcomes, higher technique success, and a predominance of use of cycler-based therapy. Several opportunities for improving technique success amenable to practice interventions have been identified.

Strategies for Improving Long-Term Survival in Peritoneal Dialysis Patients

“…Studies have found that as the cumulative numbers of PD patients treated increases, technique failure decreases significantly (2,77). In a recent study of over 40,000 PD patients, center size correlated inversely with the frequency of catheter problems (P Ͻ 0.0001), inadequate dialysis (P Ͻ 0.01), and infectious complications (P Ͻ 0.01) (2).…”

“…Age, presence of diabetes, ESRD etiology, and ESRD vintage are all independent predictors of patient survival (2). For each 1-year increase in age, the risk of death increases by 4% [adjusted hazard ratio (HR) 1.04, P Ͻ 0.0001].…”

“…For each 1-year increase in age, the risk of death increases by 4% [adjusted hazard ratio (HR) 1.04, P Ͻ 0.0001]. Patients with diabetes have a 30% increased risk of death compared with nondiabetic patients, and dialysis-naive patients have a 28% decreased risk of death compared with patients transferred from HD (2). Cardiovascular disease (CVD) accounts for most deaths in dialysis patients (approximately 50%).…”

Growing a peritoneal dialysis program: A single‐center experience

“…It is suggested that a propensity to exploit technical and non-technical advances in PD increases directly with experience and that the centers become more adept at selecting patients to receive PD and treating their complications. 49 This is illustrated by the excellent PD catheter outcomes at our PD center, which is one of the largest PD centers in the United States, treating about 120 patients. 45 Most of the U.S. PD programs are small, however, typically comprising 10-15 PD patients.…”

The Future of Peritoneal Dialysis in the United States

“…This number has many possible implications such as, but not limited to, inability to train a new patient in a timely manner; inability to do quality improvement; lack of nursing/center experience; and lack of a robust infrastructure to support patients and physicians as far as protocols and individualization of care. It has been shown that there is a strong association between center size and outcomes in PD patients (27,28). These and other subtle variables may influence how robustly home therapies are offered at an individual dialysis center.…”