Outcome in Patients on Continuous Ambulatory Peritoneal Dialysis and Haemodialysis: 4-Year Analysis of a Prospective Multicentre Study

Gokal, Ram; Jakubowski, Christopher; King, Jennie; Hunt, Linda; Bogle, Stephen; Baillod, R. A.; Marsh, Frank; Ogg, C S; Oliver, D.; Ward, M. K.; Wilkinson, Robert W.

doi:10.1016/s0022-5347(17)42826-6

Cited by 36 publications

(49 citation statements)

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“…However, the characteristics of our population are very similar to those reported for the Australian and New Zealand PD patient population [21]. Moreover, the additional variables found to be predictive of mortality in this investigation (namely serum albumin, age, and the presence of coronary artery disease) have similarly been identified as risk factors for death in other PD patient populations [33][34][35][36][37]. The study was also limited by evaluating baseline clinical and laboratory parameters only, rather than examining the effects of longitudinal changes in these variables on patient outcomes.…”

Section: Discussionsupporting

confidence: 79%

Elevated white cell count at commencement of peritoneal dialysis predicts overall and cardiac mortality

Johnson

Wiggins

Armstrong

et al. 2005

Kidney International

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Section: Discussionsupporting

confidence: 79%

Elevated white cell count at commencement of peritoneal dialysis predicts overall and cardiac mortality

Johnson

Wiggins

Armstrong

et al. 2005

Kidney International

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“…There are reports that the rates of peritonitis and exit-site infection were not significantly different between those who had dialysis assisted by a home-care nurse and those on self-dialysis [41]. The home-care nurse may assist in the treatment of peritonitis episodes and other complications, thereby contributing to a lower total hospitalization rate than that usually reported [42]. Assistance by a family member or a private nurse may enable safe CAPD treatment even in nonagenarians [43].…”

Section: Assisted Peritoneal Dialysismentioning

confidence: 99%

Assisted peritoneal dialysis as a method of choice for elderly with end-stage renal disease

Dimković

Oreopoulos

2008

Int Urol Nephrol

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In the last two decades, most developed countries have seen a continuous growth in the number of elderly patients with end-stage renal disease commencing renal replacement therapy. Despite the many advantages that peritoneal dialysis (PD) offers to elderly patients with ESRD, it is still underutilized in older patients. Older patients are much more vulnerable to the problems associated with aging, which may affect their level of independence and their long-term prognosis. Those patients have physiological changes related to aging and common health problems such as anxiety, depression, dementia, visual impairment, and cognitive impairment, all of which interfere with self-performing PD. Assistance with home-care nurses and assistance by a family member may overcome this problem. Some old but also more recent literature data justifies the idea that assisted PD may significantly contribute to increase the overall number of elderly patients who can be treated with PD at home. With assisted PD, free choice can be offered to patients with high comorbidity index who cannot perform their peritoneal exchanges by themselves. Automated peritoneal dialysis is the ideal treatment modality for elderly patients with end-stage renal disease who require assistance since this limits home-care nurse visits to only two a day. As expected, the elderly have a higher mortality rate than younger patients treated by assisted PD, but technique failure rate, overall peritonitis rate, and most quality-of-life (QoL) measures are comparable with those of younger patients. Peritoneal dialysis in nursing homes offers treatment for elderly patients without family support. In this regard, automated PD or nightly PD keeps the patient's daytime free for nursing home activities, increases socialization, and enables better rehabilitation that improves their QoL. Although withdrawal from dialysis is more frequent among nursing-home dialysis patients, this high discontinuation rate is not due to dialysis per se but rather to associated social and medical circumstances. Better communication between nursing staff and renal team is crucial for improving staff confidence and will contribute to higher utilization of PD in nursing homes.

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“…Some studies noted no difference in survival rates between patients treated with HD and patients treated with PD (1)(2)(3), whereas other studies demonstrated differences in favor of either HD (4) or PD (5)(6)(7)(8). Various sources of bias may threaten the reliability of observational studies of outcomes with HD, compared with PD, which may explain the conflicting results in different studies.…”

mentioning

confidence: 99%

Hemodialysis and Peritoneal Dialysis

Termorshuizen¹,

Korevaar²,

Dekker

et al. 2003

Journal of the American Society of Nephrology

241

176

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Various studies indicate that fair comparisons of mortality rates between hemodialysis (HD) patients and peritoneal dialysis (PD) patients are difficult because of differences in patient characteristics, because of nonconstant relative risks of death (RR), and because the survival times of patients who switch treatment modalities can be censored in different ways. The differences in mortality rates between HD and PD patients were investigated in an analysis in which these potential sources of bias were taken into account. The Netherlands Cooperative Study on the Adequacy of Dialysis is a multicenter, prospective, observational, cohort study in which new patients with ESRD are monitored until transplantation or death. A multivariate Cox regression analysis was used to analyze the mortality data according to treatment modality (HD, n = 742; PD, n = 480). No statistically significant differences in adjusted mortality rates between HD and PD patients were observed during the first 2 yr of dialysis. In the years thereafter, increases in mortality rates for PD patients and resulting decreases in RR in favor of HD were observed (e.g., months 24 to 36, adjusted RR, 0.53; 95% confidence interval, 0.31 to 0.91). This tendency was observed especially among patients >/=60 yr of age and was not influenced by the censoring strategy. These results suggest that long-term use of PD, especially among elderly patients, is associated with increases in mortality rates. Further analyses are required to determine the potential role of dialysis adequacy in the observed long-term differences in mortality rates between HD and PD patients and to establish the possible survival benefits for PD patients who switch to HD in time.

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Outcome in Patients on Continuous Ambulatory Peritoneal Dialysis and Haemodialysis: 4-Year Analysis of a Prospective Multicentre Study

Cited by 36 publications

References 0 publications

Elevated white cell count at commencement of peritoneal dialysis predicts overall and cardiac mortality

Elevated white cell count at commencement of peritoneal dialysis predicts overall and cardiac mortality

Assisted peritoneal dialysis as a method of choice for elderly with end-stage renal disease

Hemodialysis and Peritoneal Dialysis

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