scholarly journals Evolution of peritoneal dialysis technique failure from 2002 to 2017 in France. RDPLF data.

2018 ◽  
Vol 1 (3) ◽  
pp. 127-133
Author(s):  
Benoît SCHWARTZ ◽  
Fatouma TOURE
Keyword(s):  
Peritoneal Dialysis ◽  
Technique Survival ◽  
Catheter Dysfunction ◽  
Health Goal ◽  
Public Data ◽  
Public Health Goal ◽  
End Stage ◽  
Patients Experience ◽  
Technique Failure ◽  
Dialysis Technique

English AbstractIn France, 6 to 7 % of patients with end stage renal failure are treated by peritoneal dialysis (1). Despite the annual augmentation of treated patients, it’s still under public health goal. Peritoneal dialysis technique failure is one restraint of technique growth in France. The RDPLF collect data about technique survival and infections since 1986. Technique failure width is on restraint of PD growth. We used available data to describe trends in the different causes of technique failure to identify areas with feasible improvement to increase technical survival. Methods: This retrospective study includes public data from RDPLF over the 2002-2017 period.Results: More than 30% of treated patients experience technique failure each year and transfer to hemodialysis count for 33%. Main causes of HD transfer are inadequate dialysis, peritonitis, catheter dysfunction and fluid inadequacy. The study of technique failure causes trends shows a decreased mortality form 51% in 2002 to 38% in 2017 (p<0.05), an increase of transplantation access from 15% to 22% (p<0.05). Transfer to hemodialysis is stable 33% to 36% in the same period. The analysis au hemodialysis transfer shows a decrease of peritonitis from 22% in 2002 and 26% in 2004 to 13.6% in 2017 (p<0.05). It shows a light increase of catheter dysfunction from between 7-8% during 2002-2005 period, to 8.6-11.8% during 2013-2016 period (p>0.05). Conclusion: Technique failure causes evolved over the past fifteen years in France, there is an improvement in mortality and access to transplant, a decrease in peritonitis. Despite technique improvement and new PD solutions (Icodextrine based, biocompatible), there is still 10% of PD patients transferred each year to hemodialysis without favorable trends.

scholarly journals Impact of Break-In Period on the Short-Term Outcomes of Patients Started on Peritoneal Dialysis

2014 ◽  
Vol 34 (1) ◽  
pp. 49-56 ◽  
Author(s):  
Yaorong Liu ◽  
Lin Zhang ◽  
Aiwu Lin ◽  
Zhaohui Ni ◽  
Jiaqi Qian ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Surgical Intervention ◽  
Major Effect ◽  
Short Term ◽  
Technique Survival ◽  
Mechanical Complications ◽  
Catheter Dysfunction ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
Technique Failure

ObjectivesPeritoneal dialysis (PD) is one of the first-line modalities of renal replacement therapy in patients with end-stage renal disease. Guidelines recommended a break-in period of at least 2 weeks before full PD start. However, the optimal duration of the break-in period is still unclear. In the present study, we investigated the effect of various break-in periods on short-term outcomes in patients on PD.MethodsAll patients who underwent Tenckhoff catheter implantation and initiated PD in Renji Hospital, Shanghai Jiao Tong University School of Medicine, between 1 January 2001 and 31 December 2010 were included. Patients were grouped according to the duration of their break-in period: 7 days or less (BI≤7), 8 - 14 days (BI814), and more than 14 days (BI>14). Kaplan-Meier curves and log-rank tests were used to compare short-term outcomes in the various groups.ResultsOur study enrolled 657 patients (44.5% men), of whom 344, 137, and 176 patients were in the respective break-in groups. Compared with BI>14patients, BI≤7patients had a lower estimated glomerular filtration rate (5.34 ± 1.86 mL/min/1.73 m2vs 6.55 ± 1.71 mL/min/1.73 m2, p < 0.001) and lower serum albumin (33.29 ± 5.36 g/L vs 36.64 ± 5.40 g/L, p < 0.001). The incidence of mechanical complications during the first 6 months was significantly higher in BI≤7patients than in BI>14patients (8.4% vs 1.7%, p = 0.004). However, we observed no significant differences between the three groups with respect to the prevalence of catheter dysfunction requiring surgical intervention ( p > 0.05). Logistic regression analysis showed that BI≤7[relative risk: 4.322; 95% confidence interval (CI): 1.278 to 14.608; p = 0.019] was an independent predictor of catheter dysfunction, but not of catheter dysfunction requiring surgical intervention ( p > 0.05). Catheter dysfunction [hazard ratio (HR): 20.087; 95% CI: 7.326 to 55.074; p < 0.001] and peritonitis (HR: 4.533; 95% CI: 1.748 to 11.751; p = 0.002) were risk factors for technique failure during the first 6 months, but BI≤7was not correlated with technique failure.ConclusionsPatients starting PD with a break-in period of less than 1 week might experience a minor increased risk of mechanical complications, but no major effect on technique survival.

Capd Viability: A Long-Term Comparison with Hemodialysis

1996 ◽  
Vol 16 (3) ◽  
pp. 276-287 ◽  
Author(s):  
Rosario Maiorca ◽  
Giovanni C. Cancarini ◽  
Roberto Zubani ◽  
Corrado Camerini ◽  
Luigi Manili ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Retrospective Study ◽  
Patient Survival ◽  
Technique Survival ◽  
Transplantation Program ◽  
The Difference ◽  
Technique Failure ◽  
Dialysis Technique

Objective To compare the long-term viability of continuous ambulatory peritoneal dialysis (CAPD) to that of hemodialysis (HD). Design Retrospective study of patients of our institution starting dialysis between January 1,1981, and December 31, 1993, and surviving for at least 2 months. Patients Five hundred and seventy-eight new patients (51.3% on CAPD and 48.6% on HD). Main Outcomes Studied Cox -adjusted assessment of patient and technique survival, and of technique success. Differences in results for two successive periods of time. Results Patient survival did not differ between CAPD and HD after adjusting for age and comorbidity, and significantly improved in the second part of the follow-up (1987 -1993). Technique failure was significantly higher on CAPD, in which it was inversely related to age. The probability of a patient continuing on the first method of dialysis (“technique success”) was significantly lower on CAPD than on HD, but the difference decreased progressively with age and disappeared in patients ≥75 years. Conclusion CAPD is as effective as HD in preserving life in uremic patients in the long-term, and gives better results in the older elderly. In adults, the lower technique success rate may not be a problem for patients with access to a good transplantation program; for others, this drawback must be weighed against the advantages of home treatment.

Early Peritoneal Dialysis Technique Failure: Review

2018 ◽  
Vol 38 (5) ◽  
pp. 319-327 ◽  
Author(s):  
Yeoungjee Cho ◽  
Emily J. See ◽  
Htay Htay ◽  
Carmel M. Hawley ◽  
David W. Johnson
Keyword(s):  
Peritoneal Dialysis ◽  
Cost Effective ◽  
Current Evidence ◽  
Future Research ◽  
First Year ◽  
Poor Patient ◽  
End Stage ◽  
Technique Failure ◽  
Patient Retention ◽  
Dialysis Technique

There is a growing, global burden of patients with end-stage kidney disease (ESKD) requiring renal replacement therapy. Although peritoneal dialysis (PD) is considered to be the most cost-effective dialysis modality, its utilization has been declining in some regions. The first year after starting PD is thought to be a vulnerable period for technique failure, which in turn contributes to poor patient retention. Improved understanding of the risk factors for technique failure during this period may help the development of targeted strategies to lower its incidence and improve both the utilization and utility of PD. This up-to-date review will summarize current evidence regarding the definition, incidence, causes, and predictors of early PD technique failure. Promising avenues for directing future research efforts will also be discussed.

MO704THE PROGNOSTIC IMPACT OF WEIGHT GAIN AFTER PERITONEAL DIALYSIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Win Hlaing Than ◽  
Jack K C Ng ◽  
Gordon C K Chan ◽  
Winston Fung ◽  
Cheuk Chun Szeto
Keyword(s):  
Weight Loss ◽  
Body Weight ◽  
Peritoneal Dialysis ◽  
Weight Gain ◽  
Clinical Outcomes ◽  
Patient Survival ◽  
Survival Rates ◽  
Overweight And Obesity ◽  
Technique Survival ◽  
Technique Failure

Abstract Background and Aims The prevalence of obesity has increased over the past decade in patients with End Stage Kidney Disease (ESKD). Obesity at the initiation of peritoneal dialysis (PD) was reported to adversely affect clinical outcomes. However, there are few studies on the prognostic relevance of weight gain after PD. Method We reviewed the change in body weight of 954 consecutive PD patients from the initiation of dialysis to 2 years after they remained on PD. Clinical outcomes including patient survival, technique survival, and peritonitis rate in the subsequent two years were reviewed. Results The mean age was 60.3 ± 12.2 years; 535 patients (56.1%) were men and 504 (52.8%) had diabetes. After the first 2 years on PD, the average change in body weight was 1.2± 5.1 kg; their body weight was 63.0 ± 13.3 kg; body mass index (BMI) 24.4 ± 4.4 kg/m2. The patient survival rates in the subsequent two years were 64.9%, 75.0%, and 78.9% (log rank test, p = 0.008) for patients with weight loss ≥3 kg during the first 2 years of PD weight change between -3 and +3 kg, and weight gain ≥3 kg, respectively. The corresponding technique survival rates in the subsequent two years were 93.1%, 90.1%, 91.3%, respectively (p = 0.110), and the peritonitis rates were 0.7±1.5, 0.6±1.7, and 0.6±1.1 episodes per patient-year, respectively (p = 0.3). When the actual BMI after the first 2 years of PD was categorized into underweight, normal weight, marginal overweight, overweight, and obesity groups, the patient survival rates in the subsequent two years were 77.3%, 75.2%, 73.3%, 74.3%, and 75.9%, respectively (p= 0.005), and technique survival 98.0%, 91.9%, 88.0%, 92.8%, and 81.0%, respectively (p= 0.001). After adjusting for confounding clinical factors by multivariate Cox regression models, weight gain ≥ 3kg during the first 2 years of PD was an independent protective factor for technique failure (adjusted hazard ratio [AHR] 0.049; 95% confidence interval [CI] 0.004-0.554, p = 0.015), but was an adverse predictor of patient survival (AHR 2.338, 95%CI 1.149-4.757, p = 0.019). In contrast, weight loss ≥ 3kg during the first 2 years of PD did not predict subsequent patient or technique survival. Conclusion Weight gain during the first 2 years of PD confers a significant risk of subsequent mortality but appears to be associated with a lower risk of technique failure. The mechanism of this discordant risk prediction deserves further study.

Differences in peritoneal dialysis technique survival between patients treated with peritoneal dialysis systems from different companies

2018 ◽  
Vol 34 (6) ◽  
pp. 1035-1044 ◽  
Author(s):  
Neil Boudville ◽  
Shahid Ullah ◽  
Phil Clayton ◽  
Kamal Sud ◽  
Monique Borlace ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Technique Survival ◽  
Dialysis Technique

scholarly journals Predictors of Peritonitis and the Impact of Peritonitis on Clinical Outcomes of Continuous Ambulatory Peritoneal Dialysis Patients in Taiwan—10 Years’ Experience in a Single Center

2014 ◽  
Vol 34 (1) ◽  
pp. 85-94 ◽  
Author(s):  
Yao-Peng Hsieh ◽  
Chia-Chu Chang ◽  
Yao-Ko Wen ◽  
Ping-Fang Chiu ◽  
Yu Yang
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Outcomes ◽  
Cox Regression ◽  
Drop Out ◽  
Kaplan Meier ◽  
Underlying Mechanisms ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact ◽  
Technique Failure

ObjectivePeritoneal dialysis (PD) has become more prevalent as a treatment modality for end-stage renal disease, and peritonitis remains one of its most devastating complications. The aim of the present investigation was to examine the frequency and predictors of peritonitis and the impact of peritonitis on clinical outcomes.MethodsOur retrospective observational cohort study enrolled 391 patients who had been treated with continuous ambulatory PD (CAPD) for at least 90 days. Relevant demographic, biochemical, and clinical data were collected for an analysis of CAPD-associated peritonitis, technique failure, drop-out from PD, and patient mortality.ResultsThe peritonitis rate was 0.196 episodes per patient–year. Older age (>65 years) was the only identified risk factor associated with peritonitis. A multivariate Cox regression model demonstrated that technique failure occurred more often in patients experiencing peritonitis than in those free of peritonitis ( p < 0.001). Kaplan–Meier analysis revealed that the group experiencing peritonitis tended to survive longer than the group that was peritonitis-free ( p = 0.11). After multivariate adjustment, the survival advantage reached significance (hazard ratio: 0.64; 95% confidence interval: 0.46 to 0.89; p = 0.006). Compared with the peritonitis-free group, the group experiencing peritonitis also had more drop-out from PD ( p = 0.03).ConclusionsThe peritonitis rate was relatively low in the present investigation. Elderly patients were at higher risk of peritonitis episodes. Peritonitis independently predicted technique failure, in agreement with other reports. However, contrary to previous studies, all-cause mortality was better in patients experiencing peritonitis than in those free of peritonitis. The underlying mechanisms of this presumptive “peritonitis paradox” remain to be clarified.

Time-Dependent Reasons for Peritoneal Dialysis Technique Failure and Mortality

2010 ◽  
Vol 30 (2) ◽  
pp. 170-177 ◽  
Author(s):  
Inna Kolesnyk ◽  
Friedo W. Dekker ◽  
Elisabeth W. Boeschoten ◽  
Raymond T. Krediet
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Peritoneal Dialysis ◽  
The Netherlands ◽  
Patient Survival ◽  
Time Dependent ◽  
First Year ◽  
Technique Survival ◽  
Technique Failure

BackgroundPeritoneal dialysis (PD) technique failure is high compared to hemodialysis (HD). There is a lack of data on the impact of duration of PD treatment on technique survival and on whether there is a difference in risk factors with respect to early and late failure. The aim of this study was to clarify these issues by performing a time-dependent analysis of PD technique and patient survival in a large cohort of incident PD patients.MethodsWe analyzed 709 incident PD patients participating in the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD), who started their treatment between 1997 and 2007. We compared technique and patient survival on PD in 4 periods of follow-up: within the first 3 months, and after 3 – 12 months, 12 – 24 months, and 24 – 36 months of treatment. Cox proportional hazards model was used to analyze survival on PD and technique failure. Risk factors were also identified by comparing patients that were transferred to HD with those that remained on PD. Incidence rates for every cause of dropout for each period of follow-up were calculated to establish their trends with respect to PD treatment duration.ResultsThere was a significant increase in transplantation rate after the first year of treatment. The rate of switching to HD was highest during the first 3 months and decreased afterward. One-, 2- and 3-year technique survival was 87%, 76%, and 66%, respectively. Age, diabetes, and cardiovascular disease appeared to be risk factors for death on PD or switch to HD: a 1-year increase in age was associated with a relative risk (RR) of PD failure of 1.04 [95% confidence interval (CI) 1.003 – 1.06]; for diabetes, RR of stopping PD after 3 months of treatment increased from 1.8 (95% CI 1.1 – 3) during the first year to 2.2 (95% CI 1.3 – 4) after the second year; cardiovascular disease had a major impact in the earliest period (RR 2.5, 95% CI 1.2 – 5) and had a stable influence further on (RR 2, 95% CI 1.1 – 3.5). Loss of 1 mL/minute residual glomerular filtration rate (rGFR) appeared to be a significant predictor of PD failure after 3 months of treatment, but within the first 2 years, RR was 1.1 (95% CI 1.04 – 1.25).ConclusionsIn The Netherlands, transplantation is a main reason to stop PD treatment. The incidence of PD technique failure is at its highest during the earliest months after treatment initiation and decreases later due to fewer catheter and abdominal complications as well as less influence of psychosocial factors. Risk factors for PD discontinuation are those responsible for patient survival: age, cardiovascular disease, diabetes, and rGFR.

Improving Outcome of Capd: Twenty-Five Years’ Experience in a Single Korean Center

2007 ◽  
Vol 27 (4) ◽  
pp. 432-440 ◽  
Author(s):  
Seung Hyeok Han ◽  
Sang Choel Lee ◽  
Song Vogue Ahn ◽  
Jung Eun Lee ◽  
Hoon Young Choi ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Patient Survival ◽  
Significant Risk ◽  
Gram Positive ◽  
Dialysis Adequacy ◽  
Technique Survival ◽  
Cardiovascular Comorbidities ◽  
Significant Downward Trend ◽  
Technique Failure

Background Continuous ambulatory peritoneal dialysis (CAPD) is an established treatment for end-stage renal disease (ESRD). We investigated the outcome of CAPD over a period of 25 years at our institution. Methods CAPD has been performed in 2301 patients in 25 years. After excluding patients with less than 3 months of follow-up and missing data, we evaluated 1656 patients who started peritoneal dialysis between November 1981 and December 2005. Data for sex, age, primary disease, co-morbidities, follow-up duration, cause of death, and cause of technique failure were collected. We also examined data for urea kinetic modeling (UKM), beginning in 1990, and peritonitis episodes, including causative organisms, starting in 1992. Results Compared to incident patients from 1981 – 1992, mean age and incidence of ESRD caused by diabetic nephropathy increased in patients from 1993 to 2005. Technique survival after 5 and 10 years was 71.9% and 48.1% respectively. Technique survival was significantly higher in patients who started CAPD after 1992 than in those who started before 1992. Peritonitis was the main reason for technique failure. Overall peritonitis rate was 0.38 episodes per patient-year, with a significant downward trend to 0.29 per patient-year over 10 years, corresponding to a decrease in gram-positive peritonitis. Patient survival after 5 and 10 years was 69.8% and 51.8% respectively. Patient survival improved significantly during 1992 – 2005 compared to 1981 – 1992 after adjustment for age, gender, diabetes, and cardiovascular comorbidities [hazard ratio (HR) 0.68, p < 0.01]. Subgroup analysis based on UKM revealed that dialysis adequacy did not affect patient survival. However, diabetes (HR 2.78, p < 0.001), older age (per 1 year: HR 1.06; p < 0.001), serum albumin level (per 1 g/dL: increase, HR 0.52; p < 0.05), and cardiovascular comorbidities (HR 2.32, p < 0.01) were identified as significant risk factors. Conclusion Technique survival has improved due partly to a decrease in peritonitis, which was attributed to a decrease in gram-positive peritonitis. Patient survival has also improved considering increases in aged patients and ESRD caused by diabetes. The mortality rate of CAPD is still high in older, diabetic, malnourished, and cardiovascular diseased patients. A more careful management of higher risk groups will be needed to improve the outcome of CAPD patients in the future.

Seven-Year Follow-Up of Peritoneal Dialysis Patients in Taiwan

2009 ◽  
Vol 29 (4) ◽  
pp. 450-457 ◽  
Author(s):  
Chih-Chung Shiao ◽  
Tze-Wah Kao ◽  
Kuan-Yu Hung ◽  
Yin-Cheng Chen ◽  
Ming-Shiou Wu ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Peritoneal Dialysis ◽  
Survival Rate ◽  
Serum Albumin Level ◽  
Patient Survival ◽  
Survival Rates ◽  
Albumin Level ◽  
Technique Survival ◽  
Technique Failure

Background There are no Taiwanese publications and only a few Asian publications on the long-term outcome of peritoneal dialysis (PD) patients. The aim of this study was to evaluate the outcome of PD patients in Taiwan during a 7-year follow-up period. Patients and Methods This study enrolled 67 patients (23 males, mean age 46.2 ± 14.5 years) on maintenance PD. We administered the Short-Form questionnaire on 30 September 1998 and recorded major events and outcomes until 30 September 2005. We compared differences in initial parameters between groups categorized by PD patient survival and PD technique survival. Causes of mortality and transfer to hemodialysis were determined. PD patient and PD technique survival rates were measured and risk factors for patient mortality and PD technique failure were analyzed. Results Those in patient survival or PD technique survival groups had lower mean age ( p < 0.001 and 0.018 respectively) and higher serum albumin level ( p = 0.015 and 0.041 respectively) compared to those that died or failed PD. The 7-year patient survival rate was 77% and the PD technique survival rate was 58%. The independent predictors for PD technique failure included lower Mental Component Summary scores [hazard ratio (HR) = 0.85, p = 0.031] and diabetes mellitus (HR = 4.63, p < 0.001), whereas lower serum albumin level (HR = 0.22, p = 0.031), lower Physical Component Summary scores (HR = 0.67, p = 0.047), and presence of diabetes mellitus (HR = 5.123, p = 0.009) were the independent predictors for patient mortality. Conclusion For our PD patients, both patient and technique survival rates are good. Better glycemic control, adequate nutrition, and enhancement of health-related quality of life are all of potential prognostic benefit.

Survey of Continuous Ambulatory Peritoneal Dialysis in the United Kingdom, 1982

1984 ◽  
Vol 4 (4) ◽  
pp. 240-243 ◽  
Author(s):  
Ram Gokal ◽  
Frank P. Marsh
Keyword(s):  
Renal Failure ◽  
United Kingdom ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
End Stage Renal Failure ◽  
Results Of Treatment ◽  
The United Kingdom ◽  
Considerable Morbidity ◽  
End Stage ◽  
Technique Failure

Forty -one adult renal units undertaking continuous ambulatory peritoneal dialysis (CAPD) in the United Kingdom answered a questionnaire about available facilities and their own practices. The responses suggest that many units are struggling with unsatisfactory environmental facilities and inadequate staff. Working methods, diagnostic facilities and therapeutic policies varied considerably from unit to unit. We need more information about the influence of such variables on the results of CAPD and its complications, particularly peritonitis. The use of CAPO for the management of end-stage renal failure in the United Kingdom has increased dramatically since its introduction in 1978 (I, 2). Although statistics from the European Dialysis and Transplant Association (EDT A) revealed a high technique failure rate and considerable morbidity from catheter and peritonitis problems (2, 3), individual units have reported better results (4, 5, 6). Discussion with nephrologists in the United Kingdom suggested that there were marked differences between renal units in the techniques used and the facilities available for the practice of CAPD, and that these might be reflected in the results of treatment. Therefore, we circulated a questionnaire to the 59 dialysis units in the United Kingdom requesting information concerning their facilities, practices, and the ways in which they diagnosed and managed CAPD-related infection in 1982. Replies were received from 52 units; of these six were not using CAPD and five others were pediatric centres. The questionnaires from the remaining 41 adult renal units were analysed for this report.

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