Pre-dialysis renal clinic visits and patients' outcomes on peritoneal dialysis.

Abstract

To investigate the effect of pre-dialysis renal care on peritoneal dialysis (PD) patients' outcomes in China. In this retrospective cohort study, patients who started PD during January 1, 2006, to December 31, 2014, were included. Patients' medical charts were reviewed to extract the information. To explore the effect of pre-dialysis renal care on patients' outcomes, patient were divided into two groups according to whether or not they had frequent renal clinic visits: Group A (with frequent visits) and Group B (without frequent visits). A total of 668 patients were included. Patients who admitted to emergency room before PD initiations were significantly higher in Group B than in Group A (42.7 vs. 33%, p=0.01). However, there was no significant difference in the proportion of patients requiring emergency hemodialysis prior to PD commencement (20.5 vs. 24.6%, p=0.21), acute heart failure (30.2 vs. 35.4%, p=0.16) and pulmonary infection (15.4 vs. 12.1%, p=0.23) between groups. Both the mortality and technical failure rate in Group A were significantly lower as compared to Group B (p=0.003 and p<0.01, respectively). Multivariable Cox regression analysis showed frequent pre-dialysis renal clinic visits were associated with both lower mortality rate (HR 0.62, 95% CI 0.46-0.85, p=0.003) and technical failure on PD (HR 0.58, 95% CI 0.36-0.92, p=0.022). Pre-dialysis frequent clinic visits were associated with better PD outcomes. Pre-dialysis renal clinic management was suboptimal in the present cohort. More organized system to ensure people with established chronic kidney disease are well managed is necessary in China.