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Portuguese Journal of Nephrology & Hypertension

versão impressa ISSN 0872-0169

Resumo

SILVA, Cristina et al. Peritoneal dialysis in patients with vascular access problems. Port J Nephrol Hypert [online]. 2014, vol.28, n.2, pp.119-125. ISSN 0872-0169.

Vascular access problems are an important cause of compulsory transfer to peritoneal dialysis. Surprisingly, little is known about the effect of these transfers on peritoneal dialysis adequacy, patient or technique survival. We have analysed retrospectively a cohort of 75 patients treated at the Peritoneal Dialysis Unit of Centro Hospitalar Lisboa Norte - Hospital de Santa Maria during the year 2011. ‘Vascular access problems’ were defined clinically. Patient characteristics, peritoneal dialysis features and survival were compared between patients with (group 1, n = 14) and without vascular access problems (group 2, n = 61). In group 1, significantly more patients were Black and had been transferred from haemodialysis, with a considerably longer time spent on this technique. These patients were more likely to be anuric, with an inferior daily total fluid removal, lower renal and total creatinine clearance, and poorer Kt/V for urea. Peritoneal clearance and peritoneal membrane transport type did not differ between groups. Group 1 had a considerably higher exit site infection and peritonitis rate, and a lower albumin level. No significant differences were observed in unadjusted patient or technique survival between the two study groups. In the Cox multiple regression model, only a higher total creatinine clearance significantly and positively influenced the technique survival. In conclusion, the prevalence of vascular access problems of the Peritoneal Dialysis Unit was 18.7% and it justified 78.6% of transfers from the Haemodialysis Unit. These were not the ideal patients for peritoneal dialysis. Nonetheless, our data suggest that the outcome (patient and technique survival) of patients with mandatory transfer to peritoneal dialysis because of vascular access problems is similar to that achieved in patients without vascular access problems. Total creatinine clearance appeared as an independent protective factor of technique survival

Palavras-chave : Haemodialysis; peritoneal dialysis; survival; vascular access problems.

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