Predictors of patient survival in continuous ambulatory peritoneal dialysis 10-year experience in 2 major centers in Tehran

Many factors have been proposed to be associated with higher mortality in patients on continuous ambulatory peritoneal dialysis [CAPD]. However, the relative importance of these factors may differ among patients with different characteristics. We evaluated survival of patients on CAPD and its influencing factors in Iran. We enrolled 282 patients on CAPD between 1996 and 2006 at 2 major CAPD centers in Tehran. Patient survival was investigated during this period. Demographic characteristics, laboratory data, dialysis adequacy parameters, residual renal function, peritoneal transport characteristics, and nutritional status were assessed as potential predictors of the outcome. The mean duration of follow-up was 18.4 +/- 14.5 months. Sixty patients [21%] died during the studied period. In univariate analysis, age, body mass index, history and duration of hemodialysis before CAPD, diabetes mellitus, blood pressure, patient selection criteria, edema, peritonitis, renal residual function, urine volume, dialysis adequacy, and serum levels of cholesterol, triglyceride, intact parathyroid hormone, calcium, and albumin were predictors of patient survival. Multivariate analysis demonstrated that old age, diabetes mellitus, prior hemodialysis longer than 7 months, low serum albumin, calcium, trigelyceride, and parathyroid hormone levels independently predicted mortality, while the use of angiotensin-converting enzyme inhibitors was associated with a better survival. This study showed that older patients on CAPD and diabetics are at a higher risk of mortality. On the other hand, nutritional and metabolic factors are other predictors of mortality. Especial concern should be applied to good nutrition and treatment of comorbidities in these patients

Evaluation of efficacy, survival rate and complications of peritoneal catheter placement of patients with end-stage renal disease

Peritoneal dialysis [PD] as an equivalent to hemodialysis [HD] is one renal replacement therapy [RRT], which has several advantages compared to hemodialysis. However, most nephrologists are reluctant to apply this method. The purpose of this study is to assess the catheter efficiency, survival rate and complications of PD catheter placement in end-stage renal disease [ESRD] patients. From September 2002 to September 2003, 21 patients were operated by PD catheter placement in Imam Hossein Hospital, Tehran, Iran. The kind of catheter and surgical technique were identical in all patients. After surgery, patients were observed for 6 months. Out of the 21 patients, 13 [61%] were males and 8 [39%] were females. Diabetes and hypertension were the most common cause of nephropathy, mean age was 51.2 years and mean time between operation and from the beginning of PD was 9 days [range 1-14 days]. In 8 [38%] patients, the 2 weeks break-in period was ignored. Complications observed were as follows: peritonitis in 2 [9.5%], leak of dialysate in 2 [9.5%], abdominal wall hernia in 2 [9.5%], catheter malfunction in 2 [9.5%] and abdominal wall hematoma in 2 cases [9.5%]. The catheter lasted 6 months in all cases. However, 12 patients who previously received hemodialysis were more satisfied with PD. From the point of prevalence, our complications were not significantly different from previous studies. The 6-month survival rate and efficiency of catheter was very high. In addition, the rate of satisfaction of patients who received PD was also high. We suggest that more accurate studies on ESRD patients should be carried out to evaluate the use of PD in the primary stage of ESRD instead of HD