Overview of peritoneal dialysis outcomes in Northern Cyprus: a nation based study

Year 2022, , 249 - 254, 26.07.2022

Simge Bardak , Ahmet Behlül Düriye Deren Oygar

https://doi.org/10.38053/acmj.1068412

Abstract

Aim: Peritoneal dialysis (PD) is the more preferred renal replacement therapy (RRT) option for most patients with end-stage renal disease (ESRD) who can not achieve a kidney transplantation. By an enhanced national PD program, more patients may have a chance to take the advantage of this treatment option. In this study, we aim to investigate whether PD is preferred as the first dialysis treatment modality in Northern Cyprus and reveal the outcomes in order to improve the further PD program.
Material and Method: Peritoneal dialysis patients aged above 18 years who were followed between 2003-2021 in Northern Cyprus were investigated retrospectively. Demographic data, primary kidney diseases, comorbidities and previous RRT modalities were analysed. Episode(s) of peritonitis, total duration on PD therapy, switch to kidney transplantation or HD, and mortality rate were evaluated. Outcomes of elderly (≥ 65 years) and diabetic patients who were dropped out from PD were found out.
Results: A total of 123 patients aged 18-83 years were included in the study. Forty percent of 123 PD patients initiated RRT with PD. The median time was found 1 month in the rest of the patients to transfer PD from other modalities. Renal transplantation was performed in 16.8% of patients during follow-up whereas 34.7% were transferred to HD after 41 months. Inadequate dialysis (40.7%), PD-related infections (29.6%), ultrafiltration insufficiency (18.5%), mechanical complications (11.1%) were the most common causes of switching from PD to HD. The duration of being under PD therapy was 36.5 months for 46 patients who died under PD therapy. Cardiovascular events (50%) and various infections (%35) were the leading causes of mortality. A total of 48 (43.2%) PD patients had at least one episode of peritonitis. Total duration on PD treatment, PD rate as initial RRT modality, the prevalence of hypertension and diabetes mellitus (DM), peritonitis rate, and use of automated PD were not significantly different between elderly (n=34) and adult individuals (18-65 years). The duration of being under PD therapy was longer for males than females (p=0.044) and the duration of PD therapy was similar in the dropped out patients with or without DM (p=0.205).
Conclusion: A significant amount of patients received HD before initiation of PD (60%). Age is not be considered as a challenging barrier for PD initiation in Northern Cyprus. Precautions to prevent the development of peritonitis may contribute to extend the total duration of PD treatment.

Keywords

End-stage renal disease, peritoneal dialysis, renal replacement therapy

References

• GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2020; 395: 709-33.
• Tang SCW, Lai KN. Peritoneal dialysis: the ideal bridge from conservative therapy to kidney transplant. J Nephrol 2020; 33: 1189-94.
• Van Biesen W, Lameire N. Increasing peritoneal dialysis initiation worldwide: ‘there are none so blind as those who will not see’. Nephrol Dial Transplant 2020; 35: 1458-61.
• Li PK, Chow KM, Van de Luijtgaarden MW, et al. Changes in the worldwide epidemiology of peritoneal dialysis. Nat Rev Nephrol 2017; 13: 90-103.
• Pulliam J, Li NC, Maddux F, Hakim R, Finkelstein FO, Lacson E Jr. First-year outcomes of incident peritoneal dialysis patients in the United States. Am J Kidney Dis 2014; 64: 761-9.
• Ikizler TA, Kliger AS. Minimizing the risk of COVID-19 among patients on dialysis. Nat Rev Nephrol 2020; 16: 311-3.
• Briggs V, Davies S, Wilkie M. International Variations in Peritoneal Dialysis Utilization and Implications for Practice. Am J Kidney Dis 2019; 74: 101-10.
• Subramanian S, Javaid MM. Peritoneal dialysis as the dialysis initial modality of choice for renal replacement therapy initiation: moving from “Why” to “Why Not”. Blood Purif 2017; 44: 106-7.
• Mendes ML, Alves CA, Bucuvic EM, Dias DB, Ponce D. Peritoneal dialysis as the first dialysis treatment option initially unplanned. J Bras Nefrol 2017; 39: 441-6.
• Chaudhary K, Sangha H, Khanna R. Peritoneal dialysis first: rationale. Clin J Am Soc Nephrol 2011; 6: 447-56.
• Ito Y, Tawada M, Tine S, Mizuno M, Suzuki Y, Katsuno T. Current status of peritoneal dialysis in Japan. Contrib Nephrol 2018; 196: 123-8.
• Joachim E, Gardezi AI, Chan MR, Shin JI, Astor BC, Waheed S. Association of pre-transplant dialysis modality and post-transplant outcomes: a meta-analysis. Perit Dial Int 2017; 37: 259-65.
• Treharne C, Liu FX, Arici M, Crowe L, Farooqui U. Peritoneal dialysis and in-centre haemodialysis: a cost-utility analysis from a UK payer perspective. Appl Health Econ Health Policy 2014; 12: 409-20.
• Stel VS, de Jong RW, Kramer A, et al. Supplemented ERA-EDTA Registry data evaluated the frequency of dialysis, kidney transplantation, and comprehensive conservative management for patients with kidney failure in Europe. Kidney Int 2021; 100: 182-95.
• van Biesen W, Veys N, Lameire N, Vanholder R. Why less success of the peritoneal dialysis programmes in Europe? Nephrol Dial Transplant 2008; 23: 1478-81.
• Devoe DJ, Wong B, James MT, et al. Patient education and peritoneal dialysis modality selection: a systematic review and meta-analysis. Am J Kidney Dis 2016; 68: 422-33.
• Blake PG, Quinn RR, Oliver MJ. Peritoneal dialysis and the process of modality selection. Perit Dial Int 2013; 33: 233-41.
• Guo A, Mujais S. Patient and technique survival on peritoneal dialysis in the United States: evaluation in large incident cohorts. Kidney Int Suppl 2003; 3-12.
• See EJ, Johnson DW, Hawley CM, et al. Risk predictors and causes of technique failure within the first year of peritoneal dialysis: an Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) Study. Am J Kidney Dis 2018; 72: 188-97.
• Navaratnarajah A, Clemenger M, McGrory J, et al. Flexibility in peritoneal dialysis prescription: Impact on technique survival. Perit Dial Int 2021; 41: 49-56.
• Shen JI, Mitani AA, Saxena AB, Goldstein BA, Winkelmayer WC. Determinants of peritoneal dialysis technique failure in incident US patients. Perit Dial Int 2013; 33: 155-66
• Kitterer D, Segerer S, Braun N, Alscher MD, Latus J. Gender-Specific Differences in Peritoneal Dialysis. Kidney Blood Press Res 2017; 42: 276-83.
• Chidambaram M, Bargman JM, Quinn RR, Austin PC, Hux JE, Laupacis A. Patient and physician predictors of peritoneal dialysis technique failure: a population based, retrospective cohort study. Perit Dial Int 2011; 31: 565-73.
• Mujais S, Story K. Peritoneal dialysis in the US: evaluation of outcomes in contemporary cohorts. Kidney Int Suppl 2006; : S21-6.
• Zhang L, Lee WC, Wu CH, et al. Importance of non-medical reasons for dropout in patients on peritoneal dialysis. Clin Exp Nephrol 2020; 24: 1050-7.
• van de Luijtgaarden MW, Jager KJ, Segelmark M, et al. Trends in dialysis modality choice and related patient survival in the ERA-EDTA Registry over a 20-year period. Nephrol Dial Transplant 2016; 31: 120-8.
• van de Luijtgaarden MW, Noordzij M, Stel VS, et al. Effects of comorbid and demographic factors on dialysis modality choice and related patient survival in Europe. Nephrol Dial Transplant 2011; 26: 2940-7.
• Boyer A, Solis-Trapala I, Tabinor M, Davies SJ, Lambie M. Impact of the implementation of an assisted peritoneal dialysis service on peritoneal dialysis initiation. Nephrol Dial Transplant 2020; 35: 1595-601.
• Maruyama Y, Higuchi C, Io H, et al. Comparison of peritoneal dialysis and hemodialysis as first renal replacement therapy in patients with end-stage renal disease and diabetes: a systematic review. Ren Replace Ther 2019; 5: 44.