Technique Survival Research Articles

Percutaneous Transhepatic Treatment for Obstructing Retained Surgical Biliary Stents After Pediatric Liver Transplantation Without Placement of Biliary Drain

Percutaneous Transhepatic Treatment for Obstructing Retained Surgical Biliary Stents After Pediatric Liver Transplantation Without Placement of Biliary Drain

Trends in Peritoneal Dialysis Technique Survival, Death, and Transfer to Hemodialysis: A Decade of Data from the RDPLF

Introduction: There is limited information on the trends of peritoneal dialysis (PD) technique survival over time. This study aimed to estimate the effect of calendar time on technique survival, transfer to hemodialysis (HD) (and the individual causes of transfer), and patient survival. Methods: This retrospective, multicenter study, based on data from the French Language Peritoneal Dialysis Registry, analyzed 14,673 patients who initiated PD in France between January 1, 2005, and December 31, 2016. Adjusted Cox regressions with robust variance were used to examine the probability of a composite end point of either death or transfer to HD, death, and transfer to HD, accounting for the nonlinear impact of PD start time. Results: There were 10,201 (69.5%) cases of PD cessation over the study period: 5,495 (37.4%) deaths and 4,706 (32.1%) transfers to HD. The rate of PD cessation due to death or transfer to HD decreased over time (PR 0.96, 95% CI: 0.95–0.97). Compared to 2009–2010, starting PD between 2005 and 2008 or 2011 and 2016 was strongly associated with a lower rate of transfer to HD (PR 0.88, 95% CI: 0.81–0.96, and PR 0.91, 95% CI: 0.84–0.99, respectively), mostly due to a decline in the rate of infection-related transfers to HD (PR 0.96, 95% CI: 0.94–0.98). Conclusions: Rates of the composite end point of either death or transfer to HD, death, and transfer to HD have decreased in recent decades. The decline in transfers to HD rates, observed since 2011, is mainly the result of a significant decline in infection-related transfers.

Patients undergoing assisted peritoneal dialysis to show a better technique survival: A competing risk analysis.

To compare patient mortality and technique survival between patients undergoing assisted peritoneal dialysis (aPD) and self-care peritoneal dialysis (sPD). Patients who underwent peritoneal dialysis (PD) at the dialysis center of Second Affiliated Hospital of Soochow University from January 1, 2012 to December 31, 2016, were included and followed to December 31, 2019. Subjects were divided into aPD and sPD groups according to whether the patient could independently complete the PD procedure. Differences in mortality and technique failure rates were compared using competing risk analysis. A total of 384 patients were included in this study, with 274 patients in the sPD group and 110 patients in the aPD group. The multivariate competing risk regression analysis revealed that age (HR 1.03,95%CI 1.01-1.05, P<.001), aPD (HR 1.84,95%CI 1.10-3.08, P=.02), diabetes (HR 1.51, 95%CI 1.00-2.30, P=.05), residual renal function (HR 0.89, 95%CI 0.82-0.97, P=.005) and serum albumin level (HR 0.92, 95% CI 0.89-0.96, P<.001) were the independent risk factors for mortality. Besides, technique failure in aPD patients was lower than in the sPD group (HR 0.85, 95% CI 0.68-0.97, P=.03). These results found that aPD patients had higher mortality rates but lower technique failure rates than sPD patients. Higher mortality in aPD is probably related to the negative selection of the more comorbid patients. ​ ​.

Outcome measures for technique survival reported in peritoneal dialysis: A systematic review

Peritoneal dialysis (PD) technique survival is an important outcome for patients, caregivers and health professionals, however, the definition and measures used for technique survival vary. We aimed to assess the scope and consistency of definitions and measures used for technique survival in studies of patients receiving PD. MEDLINE, EMBASE and CENTRAL databases were searched for randomised controlled studies (RCTs) conducted in patients receiving PD reporting technique survival as an outcome between database inception and December 2019. The definition and measures used were extracted and independently assessed by two reviewers. We included 25 RCTs with a total of 3645 participants (41-371 per trial) and follow up ranging from 6 weeks to 4 years. Terminology used included 'technique survival' (10 studies), 'transfer to haemodialysis (HD)' (8 studies) and 'technique failure' (7 studies) with 17 different definitions. In seven studies, it was unclear whether the definition included transfer to HD, death or transplantation and eight studies reported 'transfer to HD' without further definition regarding duration or other events. Of those remaining, five studies included death in their definition of a technique event, whereas death was censored in the other five. The duration of HD necessary to qualify as an event was reported in only four (16%) studies. Of the 14 studies reporting causes of an event, all used a different list of causes. There is substantial heterogeneity in how PD technique survival is defined and measured, likely contributing to considerable variability in reported rates. Standardised measures for reporting technique survival in PD studies are required to improve comparability.

The role of incremental peritoneal dialysis among patients on peritoneal dialysis. A longitudinal analysis over 20 years.

Background: There is an ongoing increasing focus on person -centered individualized dialysis prescription. For this model, incremental peritoneal dialysis has been established as a strategy to start peritoneal dialysis, with an intention to increase the dose of peritoneal dialysis, as a consequence of renal clearance declines. In spite of being broadly accepted, the evidence of non -inferiority of the incremental approach in comparison with full dose peritoneal dialysis is weak. To disclose the possibility and safety of an incremental approach in incident patients, we assessed patients and technique survival (main outcomes) between incremental and full dose peritoneal dialysis. We also compared the effects in the clinical parameters of adequacy, urinary output and peritonitis incidence in both approaches. Methods: Following a retrospective design, we undertook an observational study in our center over 20 years. We investigated 106 patients divided into two groups, according to initial peritoneal dialysis strategy (incremental or full dose). We used multivariate multinomial model to assess predictors of peritonitis. The main outcomes were studies using a competing risk model. Results: One year after peritoneal dialysis start, our data disclosed statistically significant differences of phosphatemia and solute removal between full dose and incremental approach, favoring the latter. In an incremental approach, two or more peritoneal infections and drop out to hemodialysis were less usual. Conclusions: Incremental peritoneal prescription seems to be a good choice to start peritoneal dialysis. Potential benefits and, above all, safety reinforce the adoption of incremental peritoneal dialysis in incident patients as a strategy of individualized care, in compliance with new guidelines.

Prognostic significance of peritoneal dialysis effluent mitochondrial DNA level

BackgroundMitochondrial DNA (mtDNA) resembles bacterial DNA and potentially triggers local and systemic inflammation. We evaluate the prognostic implications of PD effluent mtDNA level in peritoneal dialysis (PD) patients. MethodsWe measured mtDNA in the PD effluent (PDE) sediment and supernatant of 168 incident PD patients. All patients were followed for hospitalization, technique and overall survival. ResultsThe median PD effluent supernatant and sediment mtDNA levels were 255.4 unit (interquartile range [IQR] 157.5–451.3) and 201.6 unit (IQR 147.8–267.3), respectively. Serum C-reactive protein level closely with PDE sediment mtDNA level (r = 0.471, p < 0.001) and less with supernatant mtDNA level (r = 0.156, p = 0.044). PDE supernatant mtDNA level correlates with dialysate-to-plasma creatinine ratio at 4 h (D/P4) (r = 0.361, p < 0.001) but not with any clinical outcome. PDE sediment mtDNA was an independent predictor of technique survival (p = 0.011) and the duration of hospitalization (p = 0.044) after adjusting for clinical confounding factors. ConclusionsPDE sediment mtDNA level significantly correlated with systemic inflammation, while PDE supernatant mtDNA level correlated with peritoneal transport. PDE sediment mtDNA level also independently predicted technique survival and duration of hospitalization. The mechanism of the different implications between PDE sediment and supernatant mtDNA levels deserves further investigations.

POS-633 TRENDS IN MORTALITY AMONG PERITONEAL DIALYSIS PATIENTS ACROSS TIME PERIODS: THE IMPACT OF PERITONEAL DIALYSIS-RELATED PERITONITIS

As the global burden of chronic kidney disease continues to increase, so does the need for a cost-effective renal replacement therapy. Peritoneal dialysis (PD) offers several advantages in end-stage renal disease but infectious peritonitis (IP) remains one of the most serious and life threatening complications of PD. The purpose of this study is to assess the prevalence and to evaluate the impact of peritonitis on patient mortality and technique survival with respect to duration of follow-up. We conducted a twenty seven years retrospective study from 1990 till december 2017 in the nephrology department, Fattouma Bourguiba University Hospital (Monastir, Tunisia). The rate of peritonitis, the causative organisms as well as the patient's outcome after its occurrence have been analyzed. We used the Cox regression model to assess whether peritonitis has a negative impact on mortality. The 476 episodes of IP were identified in 206 patients. The mean age of our patients was 45.8.1±16.8 years [11–86] (male to female: sex ratio M/F=2.43). The peritonitis rate (months × patients/peritonitis) was 17.6 (0.68 episode per year). Time to occurrence of peritonitis from the start of peritoneal exchange was 14.53±14 months. Gram-positive cocci (GC+) were involved in 54.7% of microbiologically proven IP cases presented mostly by Staphylococcus aureus. Gram-negative bacilli (GB-) ranked second (37.7%) represented mainly by Pseudomonas. The peritonitis was the main influencing factor on the technique survival causing ultrafiltration failure (p=0.02). The median survival of the DP technique was 68 months (95%, CI [47, 90]). After adjusting for confounders, peritonitis was independently associated with 95% increased risk of all-cause mortality and near 4-fold increased risk of infection-related mortality (hazard ratio, 4.98; 95% confidence interval: 2.47–8.86). Further analyses showed that peritonitis strongly influenced mortality in patients dialysed within the first 2 years. Peritonitis was independently associated with higher risk of all-cause and infection-related mortality in peritoneal dialysis patients, and its impact on technique survival was determinate. Despite the gradual decrease of its rate over periods, peritonitis remains frequent in our center and calls for optimization of means of prevention.

POS-659 PATIENT AND TECHNIQUE SURVIVAL OF DIABETIC PATIENTS ON PEERITONEAL DIALYSIS

Diabetic patients suffer from worse clinical outcomes under dialysis-independently of modality. Peritoneal dialysis however, offers a cluster of advantages in diabetic patients. The aim of this study is to investigate the long-term patient and technique survival and to identify the predictors of mortality in diabetic patients receiving PD. It is a monocenter descriptive study including PD patients between 2006 and 2020, in the center of PD of Sahloul Hospital in Sousse - Tunisia. Clinical data were available for patients who started PD during this period. They were followed until cessation of PD, death, or to october 2020. We identified 78 patients with a sex ratio of 2,25 (54 men and 24 women) with a median age of 53,5 years. The rate of peritonitis in diabetic PD patients was 56,4%, there was a marked predominance of Staphylococcus aureus . Mechanical complications were found in 39,7% of cases. Technique survival rates at 1-, 2-, 3- and 5-year were 74,3%, 50%, 30% and 4% in diabetic, and 70,1%, 43,5%, 30,6% and 15,3% in non-diabetic patients, respectively. Average technique survival for diabetic patients was significantly shorter than that of non-diabetic patients (p=0,048). The 1-, 2-, 3- and 5-year patient survival rates were 100 %, 98,7%, 98,7% and 88,4% in diabetics. History of cardiovascular complications and higher peritonitis rate were not associated with death in the diabetic patients (p= 0,584 ; p=0,297). Despite the adverse outcomes and the high mortality rate, PD remains a viable form of long-term kidney replacement therapy for diabetic patients with ESRD.

POS-652 TIME-AVERAGED RELATIVE HYDRATION INDEX PREDICTED PATIENT AND TECHNIQUE SURVIVAL IN CHINESE PERITONEAL DIALYSIS PATIENTS: A LONGITUDINAL STUDY OVER 5 YEARS

Previous studies which investigated volume status by bioimpedance spectroscopy (BIS) and the outcome of peritoneal dialysis (PD) patients were limited by cross-sectional design. We aimed to describe the longitudinal change in volume status in PD patients in Chinese PD patients, and determine its association with clinical outcomes. We performed a single-center, retrospective analysis of all PD patients who underwent repeated BIS from 2010 to 2015. The evolution of volume status was assessed by mixed linear regression model .Volume status was represented by relative hydration index (RHI) (volume of overhydration adjusted by extracellular water), and variability of volume status (VVS) was denoted by the standard deviation of all RHI. The association of time-averaged RHI and VVS on patient and technique survival was examined by a competing risk model. A total of 269 patients were followed up for a median of 47.1 months. At baseline, FO (RHI >7%) was present in 222 patients (82.5%). The mean time-averaged RHI and mean VVS was 17.6 ± 10.2% and 6.9 ± 5.2%, respectively. Although RHI of the entire cohort remained stable over time, this relation was significantly modified by baseline volume status (RHI >7% vs. ≤7%, Pinteraction =0.001) and residual urine output (<200ml/day vs. ≥ 200ml/day, Pinteraction =0.04). Persistent moderate (time-averaged RHI >15.0% to 25.0%) and persistent severe FO (time-averaged RHI>25%) was associated with significant increased risk of death (subdistribution hazard ratio [SHR] 2.65, 95% CI 1.13-6.22; SHR 4.62, 95% CI 1.98-10.76, respectively) and a trend towards technique failure (SHR 1.77, 95% CI 0.80-3.93; SHR 2.30, 95% CI 0.97-5.48). On the other hand, VVS was not a significant predictor for both patient and technique survival. Persistent FO is a strong predictor of patient and technique failure. Repeated bioimpedance measurements of volume status provide important prognostic information in PD patients.

POS-645 THE INCIDENCE AND RISK FACTORS OF PERITONEAL DIALYSIS TREATMENT FAILURE: A RETROSPECTIVE ANALYSIS AT NATIONAL KIDNEY AND TRANSPLANT INSTITUTE (NKTI)

End stage renal disease (ESRD) is a global health burden worldwide. In the Philippines, based on the Philippine Renal Disease Registry (PDRD), the number of ESRD cases from a population of 10,000 last 2013, had increased to 14,000 in 2016. NKTI, being the tertiary referral hospital for patients who are suffering from ESRD, has the largest Peritoneal Dialysis (PD) center and most number of patients on PD. It is the goal of this study to be able to share the clinical expertise and resources of the hospital on PD by being able to provide recommendations that can be translated into protocols and guidelines that will aid in improving PD technique survival.

POS-661 PERITONEAL DIALYSIS TECHNIQUE FAILURE : INCIDENCE AND PREDICTORS

Peritoneal dialysis (PD) offers similar clinical outcomes to hemodialysis (HD) at a proportion of the cost. To improve PD technique survival, we need to identify the patients at risk of this complication. The aim of this study is to estimate the incidence of technique failure (TF) in PD, and to determine its predictors in our population.

Association Between Anesthetic Dose and Technique and Oncologic Outcomes After Surgical Resection of Non-Small Cell Lung Cancer

Because of the biologic effects of volatile anesthetics on the immune system and cancer cells, it has been hypothesized that their use during non-small cell lung cancer (NSCLC) surgery may negatively affect cancer outcomes compared with total intravenous anesthesia (TIVA) with propofol. The present study evaluated the relationship between anesthetic technique and dose and oncologic outcome in NSCLC surgery. Retrospective cohort study. Surgical records collated from a single, tertiary care hospital and combined with the Scottish Cancer Registry and continuously recorded electronic anesthetic data. Patients undergoing elective lung resection for NSCLC between January 2010 and December 2014. The cohort was divided into patients receiving TIVA only and patients exposed to volatile anesthetics. Final analysis included 746 patients (342 received TIVA and 404 volatile anesthetic). Kaplan-Meier survival curves with log-rank testing were drawn for cancer-specific and overall survival. No significant differences were demonstrated for either cancer-specific (p = 0.802) or overall survival (p = 0.736). Factors influencing survival were analyzed using Cox proportional hazards modeling. Anesthetic type was not a significant predictor for cancer-specific or overall survival in univariate or multivariate Cox analysis. Volatile anesthetic exposure was quantified using area under the end-tidal expired anesthetic agent versus time curves. This was not significantly associated with cancer-specific survival on univariate (p = 0.357) or multivariate (p = 0.673) modeling. No significant relationship was demonstrated between anesthetic technique and NSCLC survival. Whether a causal relationship exists between anesthetic technique during NSCLC surgery and oncologic outcome warrants definitive investigation in a prospective, randomized trial.

Study of early complications associated with peritoneal dialysis catheters: an analysis of the New Zealand Peritoneal Dialysis Registry data

Early peritoneal dialysis catheter (PDC)-related complications are frequent and make an important contribution to long-term PD survival. We aimed to analyse the incidence and specific causes of early PDC-related complications. This study was conducted from January 2001 to December 2012, utilising the New Zealand PD Registry (NZPDR) data. The objectives of this study were to analyse the incidence and causes of PDC-related complications within 4weeks and 3months of insertion. A logistic regression analysis was conducted to analyse any demographic or clinical risk factors of early PDC-related complications. Of the 2573 PDC insertions during this period, majority 88% were surgically inserted. The number of complication within 4weeks ranged from minimum of 20% to a maximum of 34% annually, with infections and flow dysfunctions leading the causes. There has been a minor drop in the infection rates from 19 to 16% (p = 0.21), and flow dysfunction from 12 to 9% (p = 0.16), from 2001 to 2012. A reduced odds of early complication was noted in elderly individuals above 60years age, with odds ratio of (OR) of 0.73 (95% CI 0.53-0.99), while as higher odds of early complications were recorded in female gender, OR 1.41 (95% CI 1.06-1.88). Of the 10% of patients who failed to initiate PD within 90days, flow dysfunction contributed to 32%, followed by infectious and surgical causes in 16% and 15%, respectively. The median time from insertion of PDC to initiation of PD was 17days (interquartile range of 14-24days) CONCLUSIONS: Improvements in PDC insertion techniques and reduction in infection rates may result in improvements in long-term PD technique survival.

Comparison of long-term outcomes between Chinese peritoneal dialysis patients with and without diabetes: A 10-year cohort study.

This study aimed to evaluate the long-term outcomes of peritoneal dialysis (PD) patients with and without diabetes in southern China. This retrospective and observational cohort study included all adult patients with end-stage renal disease (ESRD) who received PD in our center from January 2009 to December 2017 and were followed until December 2019. Clinical outcomes were compared by Kaplan-Meier survival analysis and cumulative incidence function, and risk factors were estimated using Cox regression analyses and competing risk models. Of 401 patients receiving PD, 120 (29.9%) had type 2 diabetes mellitus (DM), and 281 (70.1%) did not have diabetes mellitus (NDM). Patients with DM were older and had more cardiovascular disease (CVD) morbidities than patients without DM. Kaplan-Meier analysis showed that patients with DM had shorter survival (Log-rank 3.215, P < 0.0001) compared with patients without DM. Patients with DM had a lower death-censored technique survival (Log-rank 2.029, P = 0.0180), however, there was no significant difference in peritonitis-free period (Log rank 1.375, P = 0.1133). These results were reproduced after taking competing events into account. Both on multivariate Cox analysis and on multivariate competing risk regression, diabetes was an independent predictor for increased mortality and technique failure, but not for peritonitis-free survival. Patients undergoing PD with DM had increased risk of mortality and technique failure, and closer monitoring and additional focus in patients with DM treated by PD are, therefore, warranted.

Repeat and Relapsing Peritonitis Microbiological Trends and Outcomes: A 21-Year Single-Center Experience.

Peritonitis is a major peritoneal dialysis complication. Despite a high cure rate, relapsing and repeat peritonitis is associated with Tenckhoff catheter biofilm and multiple episodes of peritoneal damage. In relapsing peritonitis, prompt catheter removal is mandatory; otherwise, in repeat peritonitis, there is not a clear indication for catheter removal. It is questionable if the approach to removal should be different. There are few recent data on repeat and relapsing peritonitis microbiology and clinical outcomes since most studies are from the past decade. This study evaluates the microbiology, clinical outcomes, and impact of relapsing and repeat peritonitis on technique survival and the impact of catheter removal in development of further peritonitis episodes by the same microorganism. We developed a single-center retrospective study from 1998 to 2019 that compared repeat and relapsing peritonitis with a control group in terms of causative microorganisms, cure rate, catheter removal, and permanent and temporary transfer to hemodialysis. We also compared repeat and relapsing peritonitis clinical outcomes when Tenckhoff catheter was not removed. Comparing to the control group, the repeat/relapsing group had a higher cure rate (80.4% versus 74.5%, p=0.01) and lower rate of hospitalization (10.9% versus 27.7%, p=0.01). Technique survival was superior in the repeat/relapsing group (log rank = 4.5, p=0.03). Gram-positive peritonitis was more common in the repeat/relapsing group especially Streptococci viridans (43.5% versus 21.3%, p=0.01) and Gram-negatives in the control group (26.6% vs 9.0%, p=0.02). When the Tenckhoff catheter was not removed after a repeat episode, 58.6% developed a new repeat/relapsing episode versus 60.0% in the relapsing group. Although repeat and relapsing peritonitis have a higher cure rate, it leads to further episodes of peritonitis and consequent morbidity. When Tenckhoff catheter was not removed, the probability of another peritonitis episode by the same microorganism is similar in repeat and relapsing peritonitis.

Peritoneal dialysis in Tunisia: complications, technique and patient's survival (twenty-seven years of experience in a single center).

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.

Peritoneal Dialysis After Liver Transplantation: A Systematic Review.

Background:Chronic kidney disease following liver transplantation is a major long-term complication. Most liver transplant recipients with kidney failure will be treated with dialysis instead of kidney transplantation due to noneligibility and shortage in organ availability. In this population, the role of peritoneal dialysis (PD) as a modality of kidney replacement therapy (KRT) remains unclear.Objective:To determine the feasibility regarding safety, technique survival, and dialysis efficiency of PD in liver transplant recipients requiring KRT for maintenance dialysis.Design:Systematic review.Setting:Interventional and observational studies reporting the use of PD after liver transplantation.Patients:Adult liver transplant recipients with kidney failure treated with maintenance KRT.Measurements:Extracted data included eligibility criteria, study design, demographics, and PD modality. The following outcomes of interest were extracted: rate of peritonitis and microorganisms involved, noninfectious peritoneal complications, technique survival, and kidney transplantation-censored technique survival. Non-PD complications included overall survival, liver graft dysfunction, and hospitalization rate.Methods:The following databases were searched until July 2020: MedLine/PubMed, EMBASE, CINAHL, and Cochrane Library. Two reviewers independently screening all titles and abstracts of all identified articles. Due to the limited sample size, observational designs and study heterogeneity expected, no meta-analysis was pre-planned. Descriptive statistics were used to report all results.Results:From the 5263 identified studies, 4 were included in the analysis as they reported at least 1 outcome of interest on a total of 21 liver transplant recipients, with an overall follow-up duration on PD of 19.0 (Interquartile range [IQR]: 9.5-29.5) months. Fifteen episodes of peritonitis occurred in a total cumulative PD follow-up of 514 patient-months, representing an incidence rate of 0.35 per year. These episodes did not result in PD technique failure, mortality, or impairment of liver graft function.Limitations:Limitations include the paucity of studies in the field and the small number of patients included in each report, a risk of publication bias and the impossibility to directly compare hemodialysis to PD in this population. These results, therefore, must be interpreted with caution.Conclusions:Based on limited data reporting the feasibility of PD in liver transplant recipients with kidney failure, no signal was associated with an increased risk of infectious complications. Long-term studies evaluating this modality need to be performed.Registration (PROSPERO):CRD42020218374.

Peritoneal dialysis in incident patients with primary glomerulonephritis. Results of a 20-year multicenter registry study

Background and objectivesGlomerulonephritis (GN) is one of the main causes of chronic terminal kidney disease; however, few studies assess its prognosis in dialysis. We analyze the survival and characteristics of patients on peritoneal dialysis (PD) with primary GN (PGN), and compare their results with other kidney patients. MethodsThis prospective observational study took place from 1995 to 2014. We included all incident patients who were initiated on the technique in the Levante registry. Data were transferred to an anonymized database in Access. Statistical analysis was performed using SPSS software (version 19.0). ResultsThe study included 2243 patients, with GN representing the main cause of primary kidney disease (21,5%). IgA nephropathy was the most frequent histologically confirmed form of PGN. Compared with the rest of the sample, patients with PGN were more often men (65% vs 58%, p = .004), and they were on average younger (48 years vs 55 years, p < .001). They also had fewer comorbidities and a higher rate of inclusion on the waitlist for a kidney transplant (87 vs 63%, p < .001). Patients with PGN also had more transplants (48,9%, p < .001), and this was the most frequent reason for stopping PD; beyond that, their peritonitis mean rate was lower (0,34 vs 0,45 episodes/patient-year, p < .001). Technique survival was 90,6% at one year, 71,7% at 3 years, and 59,0% at 5 years (median 76,8 months); there were no differences between groups. Survival was 94,9% at one year, 80,1% at 3 years, and 63,7% at 5 years (median 90,7 months). Patients with PGN showed better mean survival than patients with other kidney pathologies (153,5 months [95% IC: 137,0–169,9] vs 110,3 months [95% CI: 100,8–119,7], p < .001). In the multivariable analysis, the main negative risk factor influencing technique survival was a higher peritoneal transport (p = .018). Factors with a negative influence on mortality were being older (p < .001) and having any comorbidity, mainly diabetes and liver disease (p < .001). By contrast, protective survival factors were inclusion on the transplant waitlist and a higher baseline residual renal function (p = .001). ConclusionsPD has several advantages as a first dialytic treatment, and our results suggest that it is an excellent technique to manage patients with PGN while they await a kidney transplant.

Valvular Calcific Deposits and Mortality in Peritoneal Dialysis Patients: A Propensity Score-Matched Cohort Analysis

Objective: This study aimed to compare mortality between peritoneal dialysis (PD) patients with and without cardiac valve calcification (CVC). Methods: Patients undergoing PD at the dialysis center of the Second Affiliated Hospital of Soochow University from January 1, 2009, to June 31, 2016, were included and followed through December 31, 2018. The inclusion criteria were (1) age ≥18 years and (2) PD vintage ≥1 month. The exclusion criteria were (1) a history of hemodialysis or renal transplantation before PD; (2) diagnosed congenital heart disease, rheumatic heart disease, or hyperthyroid heart disease; and (3) loss to follow-up. Differences in mortality rates were compared using a Fine-Gray proportional hazards model. Results: A total of 310 patient cases were included in this study, including 237 cases without CVC (non-CVC group). The CVC group included 59 cases with aortic valve calcification (AVC), 6 cases with mitral valve calcification (MVC), and 8 cases of AVC associated with MVC. After propensity score matching, 68 pairs were selected. The multivariate competing risk regression analysis revealed that age (hazard ratio [HR]: 1.06, 95% confidence interval [95% CI]: 1.03–1.10, p < 0.001) and CVC group (HR: 1.83, 95% CI: 1.04–3.20, p < 0.05) were independent risk factors associated with mortality. No significant difference was observed in technique survival between the 2 groups. Conclusion: CVC is an independent risk factor for mortality in PD patients.

Clinical outcomes, quality of life, and costs evaluation of peritoneal dialysis management models in Shanghai Songjiang District: a multi-center and prospective cohort study

Background: The new Family-Community-Hospital (FCH) three-level comprehensive management aimed to improve the efficiency and scale of peritoneal dialysis (PD) to meet the increased population of end-stage renal disease (ESRD). Our study focused on the clinical outcomes, quality of life, and costs evaluation of this model in a multi-center and prospective cohort study. Methods: A total of 190 ESRD patients who commenced PD at Shanghai Songjiang District were enrolled. According to different PD management models, patients were divided into the Family-Community-Hospital three-level management model (n = 90) and the conventional all-course central hospital management model (n = 100). The primary outcome was clinical outcomes of PD. The secondary outcomes were health-related quality of life (HRQOL) and medical costs evaluation. Results: Compared to conventional management, community-based FCH management achieved a similar dialysis therapeutic effect, including dropout rate (p = 0.366), peritonitis rate (p = 0.965), patient survival (p = 0.441), and technique survival (p = 0.589). Follow-up data showed that similar levels of the renal and peritoneal functions, serum albumin, cholesterol and triglyceride, PTH, serum calcium, and phosphorus between the two groups (all p > 0.05). HRQOL survey showed that the FCH management model helped to improve the psychological status of PD patients, including social functioning (p = 0.006), role-emotional (p = 0.032), and mental health (p = 0.036). FCH management also reduced the hospitalization (p = 0.009) and outpatient visits (p = 0.001) and saved annual hospitalization costs (p = 0.005), outpatient costs (p = 0.026), and transport costs (p = 0.006). Conclusions: Compared with conventional management, community-based FCH management achieved similar outcomes, improved psychological health, reduced medical budgets, and thus had a good social prospect.