Peritoneal dialysis versus hemodialysis in the management of sickle cell disease patients with endstage renal disease: an observational study

Abstract

There is paucity of studies that discussed the role of peritoneal dialysis (PD) in managing end stage renal disease (ESRD) in sickle cell disease (SCD) patients. The present study compares the outcome of SCD-ESRD patients treated with hemodialysis (HD) or PD. Sixty incident ESRD patients were allotted to HD, (HD group, n=40) or PD, (PD group, n=20). Causes and severity of renal injury were assessed at the time of initiating dialysis. The primary outcome was hospital mortality at 5 years, and secondary outcomes were infection rates, incidents of vasoocclusive crisis (VOC) and acute chest syndrome (ACS), response to erythropoietic agents and improvement of cardiac function. No statistically significant differences were observed between groups in regard to patients’ characteristics. The survival at 5 years was significantly better in the patients treated with PD when compared to HD (75.0% vs. 57.5%, p=0.026). Infectious complications (15% vs 35%, p<0.001), blood transfusion requirements (p < 0.001), VOC (15% vs. 42.5%, p<0.001) and ACS (10% vs. 27.5%, p<0.001) were significantly less in the PD group. Response to erythropoietic agents and improvement of left ventricular ejection fraction (LVEF) were significantly better in the PD group (p = 0.022 and p < 0.001, respectively). This study suggests that there are better outcomes with PD compared to HD in the treatment of SCD-ESRD patients with different dialysis modalities. Key Words: SCD, HD, PD, erythropoiesis, blood transfusion, VOC, ACS, sepsis, cardiac function, survival.