Few studies evaluated over 5-year outcomes of dialysis patients. This study examined 10-year all-cause mortality and death-censored technique failure in a cohort of incident peritoneal dialysis (PD) individuals.
Methods:
Five hundred and thirty-three incident PD individuals from 2006 to 2008 were prospectively followed up for more than 10 years until 2018. Clinical characteristics at PD initiation were collected. The primary outcome was all-cause mortality, and the secondary outcome was death-censored technique failure. Cox hazards models were fit using clinical characteristics at PD initiation.
Results:
The mean age starting PD for these participants was 48 ± 16 years; 130 (24%) patients had diabetic nephropathy. During follow-up, 208 patients died, and 84 patients experienced technique failures. The 1, 3, 5, and 10 years’ survival rates for incident PD patients were 93%, 81%, 64%, and 36%, respectively, and the technical survival rates were 98%, 93%, 85%, and 62%, respectively. Mortality risk was much higher after 3 years on PD. The peritonitis rate was 0.19 episodes per patient-year, and 7 (1.3%) patients had encapsulating peritoneal sclerosis (EPS) giving an incidence rate of 3.1 of 1000 patient-years. The main causes of death were cardiovascular events (97 of 208, 47%), and technique failure was mainly due to peritonitis (41 of 84, 49%). Older age, higher Charlson comorbidity index, and lower level of education were strongly associated with mortality, and diabetic nephropathy was an independent risk factor for technique failure.
Conclusions:
The 10-year’s survival and technique survival rates of incident PD patients were 36% and 62%. Long-term PD can be continued successfully with improved outcomes and low risk for EPS.
SaranRRobinsonBAbbottKC, et al.US renal data system 2018 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis2019; 73: A7–A8.
2.
National Health Commission of the People’s Republic of China. Chinese National Renal Data System, http://www.cnrds.net (2018, accessed 27 May 2020).
3.
SaranRRobinsonBAbbottKC, et al.US Renal Data System 2018 Annual Data Report: epidemiology of kidney disease in the United States. Am J Kidney Dis2019; 73: S411–S442.
4.
PengYYeHYiC, et al.Changes in outcomes over time among incident peritoneal dialysis patients in Southern China. Perit Dial Int2019; 39: 382–389.
5.
LiPKChowKMVan de LuijtgaardenMW, et al.Changes in the worldwide epidemiology of peritoneal dialysis. Nat Rev Nephrol2017; 13: 90–103.
6.
SinghSChoiPPowerA, et al.Ten-year patient survival on maintenance haemodialysis: association with treatment time and dialysis dose. J Nephrol2013; 26: 763–770.
7.
SunYWangYYuW, et al.Association of dose and frequency on the survival of patients on maintenance of hemodialysis in China: a Kaplan–Meier and Cox-proportional hazard model analysis. Med Sci Monit2018; 24: 5329–5337.
8.
TiranathanagulKSusantitaphongPSrisawatN, et al.Ten-year survival of end-stage renal disease patients treated with high-efficiency online hemodiafiltration: a cohort study of a center in South East Asia. Nephron2018; 139: 150–158.
9.
CharlsonMEPompeiPAlesKL, et al.A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis1987; 40: 373–383.
10.
LeveyASCoreshJGreeneT, et al.Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med2006; 145: 247–254.
KawaguchiYKawanishiHMujaisS, et al.Encapsulating peritoneal sclerosis: definition, etiology, diagnosis, and treatment. International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis. Perit Dial Int2000; 20(4): S43–55.
13.
The Australia and New Zealand Dialysis and Transplant Registry. The 41th annual ANZDATA report [online], http://www.anzdata.org.au (2018, accessed 27 May 2020).
14.
KramerAPippiasMNoordzijM, et al.The European Renal Association–European Dialysis and Transplant Association (ERA-EDTA) Registry Annual Report 2016: a summary. Clin Kidney J2019; 12: 702–720.
15.
GrootemanMPvan den DorpelMABotsML, et al.Effect of online hemodiafiltration on all-cause mortality and cardiovascular outcomes. J Am Soc Nephrol2012; 23: 1087–1096.
16.
MaduellFMoresoFPonsM, et al.High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients. J Am Soc Nephrol2013; 24: 487–497.
17.
OkEAsciGTozH, et al.Mortality and cardiovascular events in online haemodiafiltration (OL-HDF) compared with high-flux dialysis: results from the Turkish OL-HDF Study. Nephrol Dial Transplant2013; 28: 192–202.
18.
JansenMAHartAAKorevaarJC, et al.Predictors of the rate of decline of residual renal function in incident dialysis patients. Kidney Int2002; 62: 1046–1053.
19.
VilarEFarringtonK. Emerging importance of residual renal function in end-stage renal failure. Semin Dial2011; 24: 487–494.
20.
RobertsMAPolkinghorneKRMcDonaldSP, et al.Secular trends in cardiovascular mortality rates of patients receiving dialysis compared with the general population. Am J Kidney Dis2011; 58: 64–72.
21.
de JagerDJGrootendorstDCJagerKJ, et al.Cardiovascular and noncardiovascular mortality among patients starting dialysis. JAMA2009; 302: 1782–1789.
22.
XiaXHeFWuX, et al.Relationship between serum uric acid and all-cause and cardiovascular mortality in patients treated with peritoneal dialysis. Am J Kidney Dis2014; 64: 257–264.
23.
ZhaoCLuoQXiaX, et al.Risk score to predict mortality in continuous ambulatory peritoneal dialysis patients. Eur J Clin Invest2014; 44: 1095–1103.
24.
MaTKChowKMKwanBC, et al.The choice of comorbidity scoring system in Chinese peritoneal dialysis patients. Clin Exp Nephrol2018; 22: 159–166.
25.
TaoSZengXLiuJ, et al.Socioeconomic status and mortality among dialysis patients: a systematic review and meta-analysis. Int Urol Nephrol2019; 51: 509–518.
26.
KimHJLeeJParkM, et al.Lower education level is a risk factor for peritonitis and technique failure but not a risk for overall mortality in peritoneal dialysis under comprehensive training system. PLoS One2017; 12: e0169063.
27.
HsiehYPChangCCWenYK, et al.Predictors of peritonitis and the impact of peritonitis on clinical outcomes of continuous ambulatory peritoneal dialysis patients in Taiwan—10 years’ experience in a single center. Perit Dial Int2014; 34: 85–94.
28.
BrownMCSimpsonKKerssensJJ, et al.Peritoneal dialysis-associated peritonitis rates and outcomes in a national cohort are not improving in the post-millennium (2000–2007). Perit Dial Int2011; 31: 639–650.
29.
YangXYiCLiuX, et al.Clinical outcome and risk factors for mortality in Chinese patients with diabetes on peritoneal dialysis: a 5-year clinical cohort study. Diabetes Res Clin Pract2013; 100: 354–361.
30.
LiPKSzetoCCPirainoB, et al.ISPD peritonitis recommendations: 2016 update on prevention and treatment. Perit Dial Int2016; 36: 481–508.
31.
BrownMCSimpsonKKerssensJJ, et al.Encapsulating peritoneal sclerosis in the new millennium: a national cohort study. Clin J Am Soc Nephrol2009; 4: 1222–1229.
32.
HuSMingPQureshiAR, et al.Peritonitis: episode sequence, microbiological variation, risk factors and clinical outcomes in a North China Peritoneal Dialysis Center. Kidney Blood Press Res2018; 43: 1573–1584.
33.
FangWNiZQianJ. Key factors for a high-quality peritoneal dialysis program—the role of the PD team and continuous quality improvement. Perit Dial Int2014; 2: S35–42.
34.
PerlJFullerDSBieberBA, et al.Peritoneal dialysis-related infection rates and outcomes: results from the peritoneal dialysis outcomes and practice patterns study (PDOPPS). Am J Kidney Dis. Epub ahead of print 10 January 2020. DOI: 10.1053/j.ajkd.2019.09.016.
35.
YuXYangX. Peritoneal dialysis in China: meeting the challenge of chronic kidney failure. Am J Kidney Dis2015; 65: 147–151.
36.
YuXYangXHuangN. Management of a rapidly growing peritoneal dialysis population at the First Affiliated Hospital of Sun Yat-sen University. Perit Dial Int2014; 2: S31–34.
37.
JohnsonDWChoYLivingstonBE, et al.Encapsulating peritoneal sclerosis: incidence, predictors, and outcomes. Kidney Int2010; 77: 904–912.
38.
KawanishiHKawaguchiYFukuiH, et al.Encapsulating peritoneal sclerosis in Japan: a prospective, controlled, multicenter study. Am J Kidney Dis2004; 44: 729–737.
39.
Pecoits-FilhoROkpechiIGDonnerJA, et al.Capturing and monitoring global differences in untreated and treated end-stage kidney disease, kidney replacement therapy modality, and outcomes. Kidney Int Suppl (2011). 2020; 10(1): e3–e9.
