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Clinical Experience |
Nephrology Department, Gamen, Rio de Janeiro, Rio de Janeiro, Brazil
Objective: Retrospective analysis of a group of elderly patients
(pts) on peritoneal dialysis (PD), CAPD, and automated PD (APD) in Rio de
Janeiro. Methods: We selected 108 non-institutionalized elderly pts
on PD at Clinica Gamen, from April 1997 to November 2006. They had been on the
program for at least 3 months. We studied pts alive (35.1%), dead (50.9%), and
switched to hemodialysis (HD) (13.8%). All of them, aged 66 years or more,
were or still are on CAPD, APD, or AAPD. We analyzed age, sex, cause of renal
failure, dialysis modality, technique survival, peritonitis rate,
comorbidities, and cause of death. Crude survival is shown as
Kaplan–Meier curves. Results: Overall there were 108 pts (48
men, 60 women); their mean age was 77.25±6.99 years (range 66–97)
with predominance of females (55.5%). The most common cause of renal failure
was hypertension (50.9%) and diabetes mellitus (43.5%). Among the comorbid
conditions, considering only the pts alive, the most frequent were
hypertension in 94.7%, depression in 50%, CVD in 42.1%, PVD in 39.4%, impaired
vision in 21%, malignancy in 10.5%, COPD in 10.5%, and dementia in 5.2%.
Considering all the 108 pts, CAPD was applied in 60 pts (55.5%), APD in 24 pts
(22.2%), AAPD in 8 pts (7.4%) and in same cases, 5 pts (4.6%) were switched
from CAPD to APD and 6 pts (5.5%) were on IPD. The mean age between the pts
still in our PD program, is 76.76±7.07 years and the technique survival
is 25.93 months. Considering these pts, the peritonitis rate in the last 5
years is 1/26.8 pt-months. Of these episodes, 41.66% were due to
staphylococci. The main causes of death were CVD in 33 pts (60%), followed by
infection in 17 pts (30.9%), 4 (7.2%) of these, from peritonitis,
cerebrovascular accident in 1 pt (1.8%), indeterminate cause in 2 pts (3.6%),
and malignancy in 1 pt (1.8%). The overall survival of these pts was 81.7% at
12 months, 70.80% at 24 months, and 51.3% at 30 months. Technique survival was
94% at 24 months, 82% at 30 months, and 82.2% at 36 months.
Conclusions: PD is a good option with a reasonable technique survival
rate. The results in terms of survival must be interpreted according to the
age and initial conditions of the pt.
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