Abstract
Peritoneal dialysis (PD) should be considered a suitable method of renal replacement therapy in acute kidney injury (AKI) patients. This study is the largest cohort providing patient characteristics, clinical practice, patterns and their relationship to outcomes in a developing country. Its objective was to describe the main determinants of patient and technique survival, including trends over time of PD treatment in AKI patients. This was a Brazilian prospective cohort study in which all adult AKI patients on PD were studied from January/2004 to January/2014. For comparison purposes, patients were divided into 2 groups according to the year of treatment: 2004-2008 and 2009-2014. Patient survival and technique failure (TF) were analyzed using the competing risk model of Fine and Gray. A total of 301 patients were included, 51 were transferred to hemodialysis (16.9%) during the study period. The main cause of TF was mechanical complication (47%) followed by peritonitis (41.2%). There was change in TF during the study period: compared to 2004-2008, patients treated at 2009-2014 had relative risk (RR) reduction of 0.86 (95% CI 0.77 – 0.96) and three independent risk factors were identified: period of treatment at 2009 and 2014, sepsis and age> 65 years. There were 180 deaths (59.8%) during the study. Death was the leading cause of dropout (77.9% of all cases) mainly by sepsis (58.3%), followed cardiovascular disease (36.1%). The overall patient survival was 41% at 30 days. Patient survival improved along study periods: compared to 2004-2008, patients treated at 2009-2014 had a RR reduction of 0.87 (95% CI 0.79 – 0.98). The independent risk factors for mortality were sepsis, age >70 years, ATN-ISS > 0.65 and positive fluid balance. As conclusion, we observed an improvement in patient survival and TF along the years even after correction for several confounders and using a competing risk approach.
Highlights
In the 1970s, acute peritoneal dialysis (PD) was widely accepted for acute kidney injury (AKI) treatment, but its practice declined in favor of hemodialysis [1,2,3,4,5]
The present study is the largest cohort about PD in AKI that showed the improvement in AKI patient survival treated with PD and in its technique failure (TF)
The demographic characteristics of our PD patients changed over time, we noted a reduction in septic patients, an increase in age and a decrease in patients admitted to intensive care unit (ICU)
Summary
In the 1970s, acute peritoneal dialysis (PD) was widely accepted for acute kidney injury (AKI) treatment, but its practice declined in favor of hemodialysis [1,2,3,4,5]. Interest in using PD to manage AKI patients has been increasing It is frequently used in developing countries because of its lower cost and minimal infrastructural requirements [4,5]. Given the paucity of good-quality evidence in this important area, additional large cohorts studies on the use of PD for AKI and its effect on clinical outcomes are necessary. The information acquired from these studies is important in fields where randomized clinical trials are difficult to perform. Another potential advantage of the analysis of large longitudinal cohort studies is related to the possibility of providing an overview of trends in patient and treatment characteristics.
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