Abstract

AGUIAR, Brigite et al. Increased peritoneal dialysis utilization and improved patient survival over a 20-year period: data from a Portuguese Peritoneal Dialysis Unit. Port J Nephrol Hypert [online]. 2016, vol.30, n.2, pp.113-120. ISSN 0872-0169.

Background: Peritoneal dialysis (PD) is an established renal replacement therapy, mainly performed at home. There is a general perception that the use of PD is declining worldwide. As countries look to develop dialysis programmes to manage the growing burden of end-stage renal disease (ESRD), it is important to place patterns of PD use in the global context. Although there has been an improvement in PD patient and technique survival over the last years, this modality still remains underutilized in Portugal. Objectives: The primary aim was to evaluate patient and technique survival in a single centre in Portugal over a 20-year period, comparing the last decade with the prior decade, and to identify clinically important factors that predict patient mortality and technique failure. The secondary aim was to determine the main reasons for patient dropout from PD. Methods: Historical cohort study including patients initiating PD between January 1992 and December 2012. Multivariate Cox regression models were developed using baseline candidate variables to predict all-cause mortality and technique survival. Results: A total of 184 patients were included (59.2% male, mean age 48.7 ± 16.9 years), on PD for 24.7 ± 21.2 months. There was an increase in PD use between the first and last decades (79 vs. 105 patients), especially in automated PD (48.1% vs. 60.0%). The main causes of PD drop out were death (34.2%), renal transplant (29.3%) and switch to HD (18.5%) due to inadequate ultrafiltration (38.2%), and peritonitis and access-related infections (29.4%). Patient survival at 5 years was 51.9% in the first decade, and 78.1% in the last decade (p < 0.001). The PD technique survival did not change from the first to the last decade. The presence of prior haemodialysis and diabetes mellitus were predictors of mortality. Conclusion: Over the last two decades, there has been an increase in PD use, and an improvement in patient survival in our Unit

Keywords : Patient survival; PD dropout; peritoneal dialysis; technique failure.

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