Remote indigenous peritoneal dialysis patients have higher risk of peritonitis, technique failure, all-cause and peritonitis-related mortality

Lim, Wai H.; Boudville, Neil; McDonald, S.; Gorham, Gillian; Johnson, David W.; Jose, Matthew

doi:10.1093/ndt/gfr070

Cited by 54 publications

(65 citation statements)

References 9 publications

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“…Our findings suggest that a racial ethnic disparity may exist for survival on peritoneal dialysis for Aboriginals in Canada. Previous literature has shown conflicting results on peritoneal dialysis and mortality in Aboriginals (10,12,14,15,17). Our findings are consistent with a recent report from Manitoba, where we investigated 161 Aboriginal patients compared with 566 non-Aboriginal patients on peritoneal dialysis and found an increase in mortality (adjusted HR=1.48, 95% CI=1.07-2.03) and peritonitis (adjusted HR=1.79, 95% CI=1.35-2.36) among Aboriginals (10,17).…”

Section: Discussionsupporting

confidence: 89%

“…This finding is congruent with studies from Alaska and the United States that also demonstrated similar outcomes for Indigenous peoples on intermittent hemodialysis compared with Caucasians (6,13). However, this finding is in direct contrast to some findings from Australia and New Zealand, where Aboriginals on peritoneal dialysis have worse outcomes with an increased risk of peritonitis, technique failure, hospitalizations, and mortality (14)(15)(16). Recently, we have also reported an increase in peritonitis and mortality rates in Aboriginals relative to Caucasians undergoing peritoneal dialysis in Manitoba, Canada (10,17).…”

Section: Introductionsupporting

confidence: 82%

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Association of Modality with Mortality among Canadian Aboriginals

Sood

Hemmelgarn

Rigatto

et al. 2012

Clinical Journal of the American Society of Nephrology

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Summary Background and objectives Previous studies have shown that Aboriginals and Caucasians experience similar outcome on dialysis in Canada. Using the Canadian Organ Replacement Registry, this study examined whether dialysis modality (peritoneal or hemodialysis) impacted mortality in Aboriginal patients. Design, setting, participants, & measurements This study identified 31,576 adult patients (hemodialysis: Aboriginal=1839, Caucasian=21,430; peritoneal dialysis: Aboriginal=554, Caucasian=6769) who initiated dialysis between January of 2000 and December of 2009. Aboriginal status was identified by self-report. Dialysis modality was determined 90 days after dialysis initiation. Multivariate Cox proportional hazards and competing risk models were constructed to determine the association between race and mortality by dialysis modality. Results During the study period, 939 (51.1%) Aboriginals and 12,798 (53.3%) Caucasians initiating hemodialysis died, whereas 166 (30.0%) and 2037 (30.1%), respectively, initiating peritoneal dialysis died. Compared with Caucasians, Aboriginals on hemodialysis had a comparable risk of mortality (adjusted hazards ratio=1.04, 95% confidence interval=0.96–1.11, P=0.37). However, on peritoneal dialysis, Aboriginals experienced a higher risk of mortality (adjusted hazards ratio=1.36, 95% confidence interval=1.13–1.62, P=0.001) and technique failure (adjusted hazards ratio=1.29, 95% confidence interval=1.03–1.60, P=0.03) than Caucasians. The risk of technique failure varied by patient age, with younger Aboriginals (<50 years old) more likely to develop technique failure than Caucasians (adjusted hazards ratio=1.76, 95% confidence interval=1.23–2.52, P=0.002). Conclusions Aboriginals on peritoneal dialysis experience higher mortality and technique failure relative to Caucasians. Reasons for this race disparity in peritoneal dialysis outcomes are unclear.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionsupporting

confidence: 82%

Association of Modality with Mortality among Canadian Aboriginals

Sood

Hemmelgarn

Rigatto

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…In line with our findings, Tonelli et al (14) reported that Canadian patients living Ͼ300 km from a dialysis center had a significantly lower risk of technique failure compared with those living closer (50 km). In contrast, Lim et al (15) recently reported in a large Australian PD population that patients residing in a nonmetropolitan location, especially remote indigenous, have a greater peritonitis risk. Further studies will need to be designed to particularly address this issue.…”

Section: Discussionmentioning

confidence: 84%

“…In a previous study, patients living far from the nearest dialysis center presented significantly higher chance of being prescribed PD (13), and therefore the distance from the center could potentially influence PD outcome and peritonitis rate (14,15); however, this hypothesis has not been evaluated in detail. Socioeconomic condition has also been described as a factor determining peritonitis risk (16), although isolated analysis of the effect of income has not been studied in depth.…”

Section: Introductionmentioning

confidence: 97%

Geographic and Educational Factors and Risk of the First Peritonitis Episode in Brazilian Peritoneal Dialysis Study (BRAZPD) Patients

Martin

Júnior

Fernandes

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Peritonitis remains as the most frequent cause of peritoneal dialysis (PD) failure, impairing patient's outcome. No large multicenter study has addressed socioeconomic, educational, and geographic issues as peritonitis risk factors in countries with a large geographic area and diverse socioeconomic conditions, such as Brazil.Design, setting, participants, & measurements Incident PD patients recruited from 114 dialysis centers and reporting to BRAZPD, a multicenter observational study, from December 2004 through October 2007 were included. Clinical, dialysis-related, demographic, and socioeconomic variables were analyzed. Patients were followed up until their first peritonitis. Cox proportional model was used to determine independent factors associated with peritonitis.Results In a cumulative follow-up of 2032 patients during 22.026 patient-months, 474 (23.3%) presented a first peritonitis episode. In contrast to earlier findings, PD modality, previous hemodialysis, diabetes, gender, age, and family income were not risk predictors. Factors independently associated with increased hazard risk were lower educational level, non-white race, region where patients live, shorter distance from dialysis center, and lower number of patients per center.Conclusions Educational level and geographic factors as well as race and center size are associated with risk for the first peritonitis, independent of socioeconomic status, PD modality, and comorbidities.

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“…Peritonitis is associated with an increased risk of technique failure and mortality among peritoneal dialysis (PD) patients (1)(2)(3). Along with improved connectology and training methods, antibiotic prophylaxis given before high-risk procedures has probably contributed to an overall decline in peritonitis rates since the early 1990s.…”

Section: Gastroscopy-related Peritonitis In Peritoneal Dialysis Patientsmentioning

confidence: 99%

Gastroscopy-Related Peritonitis in Peritoneal Dialysis Patients

Nadeau‐Fredette

Bargman

2014

Perit Dial Int

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Our 12-month catheter survival of 79.2% was similar to that reported in the literature (7,12). More than 90% of all PD catheters in our unit are inserted by a nephrologist. CONCLUSIONSIn indigenous patients with ESKD, a close-knit model of PD delivery, with components including nephrologistinserted catheters and integral involvement of PD nurses, can facilitate the provision of timely, safe, and efficient PD access, despite limitations of geographic remoteness. The incorporation of local health practitioners, indigenous allied health workers, and regular home visits by PD staff can also help to maintain therapy and prevent social dislocation. DISCLOSURESThe authors have no competing financial interests to declare.

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Remote indigenous peritoneal dialysis patients have higher risk of peritonitis, technique failure, all-cause and peritonitis-related mortality

Abstract: This registry analysis demonstrates that non-metropolitan PD patients, especially remote indigenous patients, have higher complication rates, suggesting that environmental factors are important in determining PD outcomes.

Cited by 54 publications

References 9 publications

Association of Modality with Mortality among Canadian Aboriginals

Association of Modality with Mortality among Canadian Aboriginals

Geographic and Educational Factors and Risk of the First Peritonitis Episode in Brazilian Peritoneal Dialysis Study (BRAZPD) Patients

Gastroscopy-Related Peritonitis in Peritoneal Dialysis Patients

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