RESUMO
Patients who initiated peritoneal dialysis (PD) in Sichuan Provincial People's Hospital from January 1, 2001 to December 31, 2013 were enrolled in the single center and retrospective study. Clinical and laboratory data were collected to analyze the long-term survival rates, technique survival rates and associated influencing factors. Patients were followed up until December 31, 2021 or endpoints occurred (death or stopping PD treatment). Kaplan-Meier survival curves were used to estimate survival rates and technique survival rates. Cox proportional hazards regression model was used to analyze the risk factors of death and technique failure in PD patients. A total of 373 patients were enrolled in the study, with age of (52.1±15.8) years old and 199 (53.4%) males. During the follow-up, 154 (41.3%) patients died, 72 (19.3%) patients transferred to hemodialysis, and 40 (10.7%) patients received kidney transplant. Kaplan-Meier survival curves revealed that overall survival rates of PD patients at 1, 3, 5, 7, and 10 years were 92.2%, 76.6%, 66.0%, 52.4% and 38.6%, respectively. Technique survival rates were 93.5%, 84.8%, 74.2%, 62.8% and 44.5% at 1, 3, 5, 7, and 10 years, respectively. Multivariate Cox regression model results showed that age ( HR=1.055, 95% CI 1.039-1.073, P<0.001), transfer from hemodialysis ( HR=2.212, 95% CI 1.514-3.231, P<0.001), episodes of peritonitis ( HR=2.141, 95% CI 1.194-3.837, P=0.011), Charlson comorbidity index ( HR=1.525, 95% CI 1.305-1.783, P<0.001), and baseline albumin ( HR=0.951, 95% CI 0.925-0.978, P<0.001) were independent influencing factors of survival in PD patients. Episodes of peritonitis ( HR=2.327, 95% CI 1.274-4.250, P=0.006) and Charlson comorbidity index ( HR=1.244, 95% CI 1.035-1.496, P=0.020) were independent influencing factors of technique survival in PD patients. PD patients have good early survival rates and technical survival rates, but long-term outcomes need to be further improved. Peritonitis is a major risk factor for low long-term survival rates and technical survival rates in PD patients.
RESUMO
BACKGROUND/AIMS: Continuous ambulatory peritoneal dialysis (CAPD) is an established treatment in patients with end-stage renal disease (ESRD), and innovations in the connection system have improved the survival of peritoneal dialysis patients over the last two decades. We investigated the outcome of CAPD over a 15-year period at our institution. METHODS: Patients who underwent peritoneal dialysis since 1994 were recruited retrospectively. Patients younger than 15 years at the initiation of CAPD and those who had less than 1 month of follow-up or missing data were excluded. The technique survival rate and causes of technique failure were evaluated. RESULTS: In all, 608 CAPD patients (342 males, 56.3%) were analyzed using the Kaplan-Meier method and log-rank test. The mean age at the start of CAPD was 50.7+/-15.1 years and the mean duration of CAPD was 50.2+/-41.5 months. The most common primary renal disease was diabetes (39.6%), followed by chronic glomerulonephritis (37.2%) and hypertension (13.0%). The 1-, 3-, 5-, and 10-year death-censored technique survival rates were 97.3, 91.7, 82.8, and 67.5%, respectively. Sex or diabetic status did not affect the technique survival rate. Patients younger than 60 years at the start of CAPD had a better technique survival than older patients (p=0.005). The main cause of technique failure was peritonitis (71.6%), followed by mechanical malfunction (10.5%), ultrafiltration failure (7.4%), and inadequate dialysis (6.3%). CONCLUSIONS: Complicating peritonitis was the most common cause of CAPD technique failure at our center. To reduce the technique failure in high-risk groups, more intensive management is needed.