SAT-285 THE CURRENT STATE AND THE TRENDS IN PERITONEAL DIALYSIS TECHNIQUE FAILURE: EXPERIENCE OVER TWENTY SEVEN YEARS

Abstract

InTunisia, only 2.7 % of patients with end stage renal disease are treated by peritoneal dialysis (PD). Despite the annual augmentation of treated patients, it’s still under public health goal. PD technique failure is one restraint of technique growth in Tunisia. The purpose of this study was to describe the technical survival and the different causes of technique failure as well as their evolution over twenty seven years. The present study was led on data from the RDPLF registry including 304 patients undergoing peritoneal dialysis in the nephrology Department, Fattouma Bourguiba University Hospital (Monastir, Tunisia). It is a retrospective study performed between 1990 and December 2017. Out of the overall population, 288 withdrew DP after a mean period of 19.8 months. The median survival of the DP technique was 68 months (95%, CI [47, 90]). DP exit was precocious (<1 year) in 68 cases (23.6%) with a median time of 228 days [150,288]. The dropout rate at 1, 2, 3, 4, and 5 years was respectively 23.6%, 55.2%, 74.3%, 84%, and 90.3%. No cases of renal function recovery, indicating PD drop out, were observed. Transfer to hemodialysis was the main cause of dropout (49.6%). Death was responsible for 40% of the study abandonment with renal transplantation coming next (10.4%). The death was unrelated to PD in 82% of cases mostly due to considerable burden of cardiovascular disease (34 patients). Sepsis dominates the death’s reason related to DP. Ultrafiltration failure was the most important cause of technique failure (43%) followed by infections, catheter dysfunction, psychological intolerance and malnutrition in 30.2%, 18.9%, 8.4% and 0.6% respectively. Technique failure causes evolved over the past twenty seven years, there is an improvement in mortality but transfer to hemodialysis is still 10-20% each year. There were 3 independent predictors of technique failure in our cohort, namely: age (p=0.01), Charlson score (p=0.008) and occurrence of peritonitis (p<0.01). Despite technique improvement, transfer to hemodialysis is still a frequent event in DP. Its mostly late occurrence in our cohort is explained in part by the prevalence of ultrafiltration failure as etiology without favorable trends.