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Clinical |
1 Department of Internal Medicine, The Institute of Kidney Disease, Yonsei University College of Medicine, Seoul; 2 Department of Internal Medicine, Kwandong University, Kyungki-do; 3 Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
Correspondence to: H.Y. Lee, Department of Internal Medicine, Yonsei
University College of Medicine, 134 Shinchondong, Seodaemun-gu, Seoul,
120-752,
Korea.
hyl{at}yumc.yonsei.ac.kr
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,
comorbidities, 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.
KEY WORDS: CAPD; survival; peritonitis.
Received 14 August 2006; accepted 15 December 2006.
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