Peritoneal Dialysis in Brazil: Twenty-Five Years of Experience in a Single Center

Abstract

Objectives To evaluate patient and technique survival and to provide an analysis of peritoneal dialysis (PD)-related peritonitis in 25 years of experience in a single center. Study Design Retrospective study of incident patients on PD from July 1980 to July 2005. Setting Single, university based, Brazilian dialysis program. Patients 680 patients were analyzed in our study from July 1980 to July 2005, with a cumulative experience of 15303 patient-months. All patients over 15 years of age entering the dialysis program were included in the study. Patients with less than 30 days of follow-up were excluded. Biochemical and demographic variables, peritonitis episodes, and patient and technique survival were analyzed. Results Mean age at start of PD was 53 ± 16 years; diabetic nephropathy was the main cause of chronic kidney disease. Cardiovascular disease was the main cause of death (44%); peritonitis was responsible for 16% of fatal events. The predictors of death in our study were diabetes [relative risk (RR) 1.23, p < 0.01], advanced age (RR 1.58, p < 0.001), low serum albumin level (RR 1.25, p < 0.01), and low serum phosphate level (RR 1.39, p < 0.001) upon starting PD. There were 1048 cases of peritonitis over the 25-year period, with a significant reduction in incidence after the introduction of the double-bag system. The number of incident PD patients originating from hemodialysis increased threefold over the observation period ( p < 0.001), with a similar increase in comorbidities over time. Conclusion In the largest single-center report of PD experience in Latin America, we describe the overall rate and trends over time of peritonitis as well as patient and technique survival, which are similar to previous reports. Significant changes in peritonitis rates and causative organisms as well as a significant time-dependent increase in high-risk patients starting PD were observed.

Comparing the Effect of Dressing Versus No-dressing on Exit Site Infection and Peritonitis in Chronic Ambulatory Peritoneal Dialysis Patients

“…[ 23 ] and Moraes et al . [ 31 ] have reported culture negative peritonitis similar to our study (33.7% and 26% respectively).…”

“…Fernandes et al ., in a large national multicenter study (Brazilian Peritoneal Dialysis Multicenter Study),[ 30 ] have reported an overall peritonitis rate of one episode every 30 months with a mean follow-up of 13.6 months (most frequently due to S. aureus ), while Moraes et al ., in a single center study[ 31 ] have reported one episode every 14.63 months when describing 25-year cumulative data in Brazil.…”

“…Furthermore, Moraes et al . and Caramori[ 31 33 ] have reported S. aureus as the major etiologic agent in peritonitis patients. However, Barretti et al .…”

Improving the Quality of a Peritoneal Dialysis Service: Learning From Experience

“…The success of a PD service programme depends on many factors that are interlinked and inseparable from one another (Moraes et al 2009;Nayak et al 2012). Nayak (2007) has defined a dozen key points for a successful programme including patient selection, personnel management, product selection, PD prescription and pharmacotherapy, protein calorie intake, patient on line support, peritonitis, exit-site infection and other complication, preservation or renal function, physiotherapy and rehabilitation, purse management of patients, post-graduation fellowship and academic activities.…”

Focus on peritoneal dialysis training: working to decrease peritonitis rates

“…It contributes to ∼20% of PD technique failures [1], results in an overall mortality rate of 2-6% [2,3] and is a major barrier to the selection of PD as a renal replacement therapy modality by patients with end-stage kidney disease (ESKD). Single-centre studies in Korea [4], Brazil [5], Portugal [6] and Taiwan [7] have reported decreasing peritonitis rates over time. This pleasing trend has been ascribed primarily to improvements in PD connectology [8] and exit site care [9] as these innovations have resulted in decreased risks of touch contamination, intra-luminal entry of organisms or exit site colonization or infection leading to reduced peri-luminal entry of organisms.…”