Abstract
Introductionperitoneal dialysis (PD) is a renal replacement therapy method that offers various advantages to end-stage renal disease patients. The aim of our study was to analyze patient characteristics, peritonitis and clinical outcome over a 27-year period of PD in our center.Methodsretrospective study of incident patients on PD from January 1990 to December 2017. A total of 304 patients were enrolled in the study group. All patients over 15 years of age entering the dialysis program were included in the study. Patients dropping out from PD within three months were all excluded. Biochemical and demographic variables, peritonitis episodes and patient and technique survival were analyzed.Resultsthe PD prevalence in our center was 4.5% during the study period; the mean age was 46.47 ± 18.6 years; diabetic nephropathy was the main cause of chronic kidney disease: 35.5% (n=108). Cardiovascular disease was the main cause of death: 39.6% (n=34). The peritonitis rate was 0.68 episode per patient-year. Ultrafiltration failure was the most important cause of PD withdrawal: 43% (n=60). Occurrence of peritonitis was the only independent predictor of technique failure: adjusted relative risk [aRR] 5.07, 95% CI 2.69-9.58; p<0.001. The overall non-adjusted patient survival was around 100%, 95% and less than 20% at 1, 4 and 25 years respectively basing on the Kaplan-Meier analysis. The group undergoing renal transplantation had the best survival rate.Conclusionperitonitis remains the most common complication as well as the most provider of technique failure and patient´s transfer to hemodialysis. The technique survival was better in case of absence of peritonitis. However, our series showed the superiority of hemodialysis over PD in terms of overall patient survival.
Highlights
As the global burden of chronic kidney disease continues to increase, so does the need for a costeffective renal replacement therapy
The evolution can be enamelled with complications; the most serious and lifethreatening complication remain the infectious peritonitis while impacting the technique survival as well as the mortality in Peritoneal dialysis (PD)
Our experience with the PD had known three different periods: 1990-2000, 20012006 and 2007-2017; the difference had concerned the type of catheter, the placement technique and time to start the exchange
Summary
As the global burden of chronic kidney disease continues to increase, so does the need for a costeffective renal replacement therapy. Peritoneal dialysis (PD) is a method that offers various advantages to end-stage renal disease patients. This therapy is expanding around the world despite the reluctance of some patients and doctors; its estimated in 2018 that the frequency of PD use approaches 11% of dialysis population worldwide [1,2]. The evolution can be enamelled with complications; the most serious and lifethreatening complication remain the infectious peritonitis while impacting the technique survival as well as the mortality in PD. In this context, we had conducted our study aiming to analyze the epidemiology, patient characteristics and clinical outcome over a 27-year period of PD in a single center (Monastir). We were interested to evaluate the complications occurring essentially peritonitis (prevalence, microbiological profile, potential risk factors involved and its impact throughout the period of follow-up)
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