Early outcomes of peritoneal dialysis in a middle-income country: A retrospective cohort study of a large dialysis network in Colombia.

BACKGROUND: The first year of dialysis is critical given the significant risk for complications following dialysis initiation. We analysed complications during the first year among incident peritoneal dialysis (PD) patients. METHODS: This retrospective cohort study comprised adult kidney failure patients starting PD in Baxter Renal Care Services in Colombia, receiving their first PD catheter between 1 January 2017 and 31 December 2020 and were followed up for up to 1 year. We analysed incidence, causes and factors associated with complications using logistic regression and transfer to haemodialysis (HD) using the Fine-Gray regression model. RESULTS: Among 4743 patients receiving their first PD catheter: 4628 (97.6%) of catheter implantations were successful; 377 (7.9%) patients experienced early complications. The incidence rate of complications during the year was 0.51 events per patient-year (95% CI: 0.48-0.54). Age, obesity and urgent start were associated with higher probability of complications after catheter implantation. The cumulative incidence of transfer to HD within 1 year of PD initiation was 10.1% [95% CI: 9.2-11.1%]. The hazard function for transfer to HD showed an accelerating pattern during the first month followed by progressive decrease during the first year. CONCLUSIONS: In this large population of incident PD patients, there is a high primary catheter placement success rate. Urgent start, age ≥65 years, obesity, centre size ≥150 PD patients and diabetes were risk factors associated with early complications. The follow-up of the cohort from day 1 of PD treatment showed that the risk for transfer to HD was higher during the first month.

Mortalidad observada versus esperada en una red de unidades de diálisis en Colombia / Observed versus expected mortality in a network of dialysis units in Colombia

Resumen Antecedentes: la mortalidad en diálisis es uno de los principales indicadores de gestión clínica y se ve influenciada por diversos factores sociodemográficos y clínicos. Objetivos: calcular la mortalidad observada versus la esperada en las unidades de diálisis de la red de RTS en Colombia. Métodos: cohorte histórica de pacientes mayores de 18 años, prevalentes en diálisis entre el 1 de enero y el 31 de diciembre de 2012, de 51 unidades renales de la red Renal Therapy Services (RTS). Se calculó la razón estandarizada de mortalidad (REM) siguiendo la metodología propuesta por la Universidad de Michigan Centro de Costos y Epidemiologic Renal (UM-KECC); se implementó un modelo de supervivencia de riesgos proporcionales de Cox en dos etapas, la primera estimó los parámetros asociados con las variables explicativas y la segunda estandarizó los resultados. Resultados: se evaluaron 9798 pacientes, 4125 (42.1%) fueron mujeres, la media de edad fue de 59 años (DE=15.6). Se observaron 1253 eventos de muerte (12.7%). El modelo arrojó un valor de 1067 muertes esperadas, con un valor estimado de REM de 1.17 (IC95%: 1.11-1.24). La REM fue mayor para pacientes diabéticos 1.28 (IC95%:1.19-1.38) y mujeres (1.36 (IC95%: 1.25-1.48); y varió significativamente por zona del país (1.11 a 2.0). Conclusiones: encontramos diferencias importantes en la REM según sexo, presencia de diabetes y por zonas del país. Se requiere mediante nuevos estudios entender mejor la influencia de estas y otras variables sobre el fenómeno de mortalidad en diálisis en nuestro contexto. (Acta Med Colomb 2017; 42: 106-111).

Abstract Background: mortality in dialysis is one of the main indicators of clinical management and is influenced by various socio-demographic and clinical factors. Objectives: to calculate the observed versus expected mortality in the dialysis units of the RTS network in Colombia. Methods: a historical cohort of patients older than 18 years, prevalent on dialysis between January 1 and December 31, 2012, of 51 renal units of the Renal Therapy Services (RTS) network. The standardized mortality ratio (SMR) was calculated following the methodology proposed by the University of Michigan Center for Costs and Renal Epidemiology (UM-KECC); a Cox proportional hazards survival model was implemented in two stages, the first estimated the parameters associated with the explanatory variables and the second standardized the results. Results: 9798 patients were evaluated, 4125 (42.1%) were women. The mean age was 59 years (SD = 15.6). There were 1253 death events (12.7%). The model gave a value of 1067 expected deaths, with an estimated SMR value of 1.17 (95% CI: 1.11-1.24). SMR was greater for diabetic patients 1.28 (95% CI: 1.19-1.38) and women (1.36 (95% CI: 1.25-1.48)) and it varied significantly depending on the region of the country (1.11 to 2.0). Conclusions: important differences in SMR according to sex, presence of diabetes and by regions of the country were found. Further studies are required to better understand the influence of these and other variables on the mortality phenomenon in dialysis in our context. (Acta Med Colomb 2017; 42: 106-111).

Early Peritonitis in a Large Peritoneal Dialysis Provider System in Colombia.

♦ BACKGROUND: Peritonitis is the most important complication of peritoneal dialysis (PD), and early peritonitis rate is predictive of the subsequent course on PD. Our aim was to calculate the early peritonitis rate and to identify characteristics and predisposing factors in a large nationwide PD provider network in Colombia. ♦ METHODS: This was a historical observational cohort study of all adult patients starting PD between January 1, 2012, and December 31, 2013, in 49 renal facilities in the Renal Therapy Services in Colombia. We studied the peritonitis rate in the first 90 days of treatment, its causative micro-organisms, its predictors and its variation with time on PD and between individual facilities. ♦ RESULTS: A total of 3,525 patients initiated PD, with 176 episodes of peritonitis during 752 patient-years of follow-up for a rate of 0.23 episodes per patient year equivalent to 1 every 52 months. In 41 of 49 units, the rate was better than 1 per 33 months, and in 45, it was better than 1 per 24 months. Peritonitis rates did not differ with age, ethnicity, socioeconomic status, or PD modality. We identified high incidence risk periods at 2 to 5 weeks after initiation of PD and again at 10 to 12 weeks. ♦ CONCLUSION: An excellent peritonitis rate was achieved across a large nationwide network. This occurred in the context of high nationwide PD utilization and despite high rates of socioeconomic deprivation. We propose that a key factor in achieving this was a standardized approach to management of patients.

Outcomes of a peritoneal dialysis program in remote communities within Colombia.

BACKGROUND AND OBJECTIVE: Colombia is a country of diverse geographic regions, some with mountainous terrain that can make access to urban areas difficult for individuals who live in remote areas. In 2005, a program was initiated to establish remote peritoneal dialysis (PD) centers in Colombia to improve access to PD for patients with end-stage renal disease who face geographic or financial access barriers. PATIENTS AND METHODS: The present study was a multi-center cohort observational study of prevalent home PD patients who were at least 18 years of age and were being managed by one of nine established remote PD centers in Colombia over a 2-year period. Data were collected from clinical records, databases, and patient interviews. Patient survival, incidence of peritonitis, and rate of withdrawal from PD therapy were assessed. RESULTS: A total of 345 patients were eligible for the study. The majority (87.8%) of patients lived on one to two times a minimum monthly salary (equivalent to US$243 - US$486). On average, patients traveled 1.2 hours and 4.3 hours from their home to their remote PD center or an urban reference renal clinic, respectively. The incidence rate of peritonitis was 2.54 episodes per 100 patient-months of therapy. A bivariate analysis showed a significantly higher risk of peritonitis in patients who were living on less than one times a monthly minimum salary (p < 0.05) or who had a dirt, cement, or unfinished wood floor (p < 0.05). The 1-year and 2-year patient survival rates were 92.44% and 81.55%, respectively. The 1-year and 2-year technique survival rates were 97.27% and 89.78%, respectively. CONCLUSIONS: With the support of remote PD centers that mitigate geographic and financial barriers to healthcare, home PD therapy is a safe and appropriate treatment option for patients who live in remote areas in Colombia.

Frecuencia y costos de hospitalización en una población de pacientes en diálisis en Colombia / Hospitalisation frequency and costs in a population of Colombian dialysis patients

Antecedentes. Los eventos de hospitalización son frecuentes en pacientes con enfermedad renal crónica terminal. Objetivo. Medir la frecuencia, duración de los eventos de hospitalización y el peso económico de ellas en estas población. Métodos. Estudio de cohorte dinámica retrospectiva, de pacientes prevalentes en terapia dialítica durante el año 2010. Se midió la frecuencia de hospitalización, tanto en hemodiálisis (HD) como en diálisis peritoneal (DP), El número de días de hospitalización, el monto total de la cuenta hospitalaria y el costo promedio del día de hospitalización. Se evaluaron los factores relacionados con el costo de hospitalización mediante análisis multivariable con un modelo lineal generalizado gama con enlace log. Resultados. La tasa de hospitalización fue 0,72 hospitalizaciones por pacienteaño, con 6,32 días hospitalarios por pacienteaño y media de 8,68 días por hospitalización. No hubo diferencias en estas tasas entre pacientes de hemodiálisis y de diálisis peritoneal. El monto total de la cuenta tuvo una mediana de $2.567.680. Conclusion. La población de estudio tuvo unas tasas de hospitalización y de días de estancia hospitalaria menores que en otros reportes. No se encontraron diferencias en estas tasas entre los pacientes de HD y DP.

Background and objectives. Chronic renal disease patients are often hospitalised. The present study was carried out as no studies have measured such population's hospitalisation frequency and duration in Colombia nor has their economic burden been analysed. Methods. This was a dynamic retrospective cohort study of patients receiving dialysis therapy during 2010. Haemodialysis (HD) and peritoneal dialysis (PD hospitalisation frequency was measured, as were the number of days spent in hospital, total hospital bill and average cost per day of hospitalisation. Multivariate analysis was used for evaluating factors related to hospitalisation cost (i.e. a generalised linear model with log link). Results. Hospitalisation rate was 0.72 hospitalisations per patient/ year, 6.32 days were spent in hospital per patient/year and average hospitalisation rate was 8.68 days. No differences were observed between haemodialysis patients and peritoneal dialysis regarding such rates. Average hospitalisation bill was $2,567,680. Conclusion. The study population had higher hospitalisation rates and spent less days in hospital than that stated in other reports. No differences were observed between HD and PD patients regarding these rates.