Abstract
Background and Aims
The PD modality is usually modulated according to the PET and dialysis adequacy during follow-up but, initial modality choice generally depends on patient preferences and lifestyle regardless of patients’ baseline transport status. However, the relationship between baseline transport status, the PD modality chosen, and technical survival is not well established. Peritonitis is one of the leading causes of technical failure, hospitalization, and death in PD. While obesity, low albumin levels, exit-site infections, and nasal staphylococcus carriage are well-defined risk factors for peritonitis, some suggest CAPD could be another risk factor due to increased daily connection to PD. Many studies indicated that CAPD and APD have similar technical survival rates. In this study, we aimed to identify the impact of the baseline transport status on technical survival of CAPD and APD. We also investigated peritonitis risk of modalities considering all defined risk factors.
Method
This is a retrospective, single-center, cohort study of incident adult PD patients followed-up between January 2010 and January 2020. One hundred and thirty-six patients, followed-up for at least three years, were included. Patients with malignancy and who had less than 1.7 Kt/V per week were excluded. Peritonitis is defined according to the "International Society Peritoneal Dialysis" guideline. According to the baseline PET, patients were divided into two groups as follows; 1) high or high average transporters and 2) low or low average transporters. Risk factors for peritonitis, five years, and overall technical survival of both modalities according to baseline transport status were determined.
Results
The mean age was 35.5±12 years, and the median follow-up time was 47 (36-178) months. Sixty-six (48%) of the patients were female. Patients' first-year Kt/V per week was 2.18±0.4, and the mean ultrafiltration was 0.9±0.4 liters. 26 (19%) of the patients had diabetes mellitus, 57(42%) patients had hypertension, and 27 (20%) of the patients had a history of hemodialysis of more than three months. 89 (65%) of the patients were performing CAPD, 59 (66%) of whom were low or low-average transporters. 47(35%) of patients were performing APD and 28(60%) of whom were high or high-average transporters. During the follow-up, a total of 71 peritonitis episodes were observed, and the incidence of peritonitis was 0.13 episodes/year. Univariate logistic regression analysis showed that CAPD, low education level (being primary school graduate or illiterate), HD treatment before PD, and bathing less than once per week were associated with peritonitis risk. However, multivariate analysis of associated factors demonstrated that only CAPD was a significant risk factor for peritonitis [odds ratio:2.360 (95% confidence interval:1.075-5.180), p=0.03]. Kaplan-Meier survival analysis showed that low or low-average transporters and high or high-average transporters had similar technical survival rates in both CAPD or APD at the end of three years (figure 1). Similar rates were found in overall survival.
Conclusion
In our study, APD and CAPD patients had similar technical survival regardless of the peritoneal transport characteristics. However, CAPD was found to be a factor for peritonitis. Thus, it may be appropriate to initiate the PD treatment with APD modality and evaluate patients to switch modalities with PET only in case of peritoneal dialysis inadequacy.
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