Peritoneal dialysis in Tunisia: complications, technique and patient´s survival (twenty-seven years of experience in a single center)

Abstract

Introduction peritoneal dialysis (PD) is a renal replacement therapy method that offers various advantages to end-stage renal disease patients. The aim of our study was to analyze patient characteristics, peritonitis and clinical outcome over a 27-year period of PD in our center. Methods retrospective study of incident patients on PD from January 1990 to December 2017. A total of 304 patients were enrolled in the study group. All patients over 15 years of age entering the dialysis program were included in the study. Patients dropping out from PD within three months were all excluded. Biochemical and demographic variables, peritonitis episodes and patient and technique survival were analyzed. Results the PD prevalence in our center was 4.5% during the study period; the mean age was 46.47 ± 18.6 years; diabetic nephropathy was the main cause of chronic kidney disease: 35.5% (n=108). Cardiovascular disease was the main cause of death: 39.6% (n=34). The peritonitis rate was 0.68 episode per patient-year. Ultrafiltration failure was the most important cause of PD withdrawal: 43% (n=60). Occurrence of peritonitis was the only independent predictor of technique failure: adjusted relative risk [aRR] 5.07, 95% CI 2.69-9.58; p<0.001. The overall non-adjusted patient survival was around 100%, 95% and less than 20% at 1, 4 and 25 years respectively basing on the Kaplan-Meier analysis. The group undergoing renal transplantation had the best survival rate. Conclusion peritonitis remains the most common complication as well as the most provider of technique failure and patient´s transfer to hemodialysis. The technique survival was better in case of absence of peritonitis. However, our series showed the superiority of hemodialysis over PD in terms of overall patient survival.

Evaluation of Peritoneal Dialysis Health Literacy in Peritoneal Dialysis Patients

“…We can speculate that, because of hypertension, patients tend to pay more attention to their health and learn more health-related knowledge and solutions than the other respondents, thus lowering the chance of contracting peritonitis. The results of this research are similar to those reported by Salem et al (2021).…”

“…Therefore, the longer the PD time and the more mature the technology, the more likely PD failure, and peritonitis infection can be reduced. This result is similar to the ndings of Salem et al ( 2021), who studied PD patients in Tunisia [15]. The results indicate that new PD patients should strengthen their knowledge about the technical operation of PD work by regularly attending teaching activities.…”

Incidence, Clinical Outcome and Changes of Peritoneal Membrane Transport Status in Treated Continuous Ambulatory Peritoneal Dialysis (Capd) Related Peritonitis

“…Over the years, there was a change in the causative microorganism profile: predominance of gram-negative bacilli between 1996 and 2000, then the emergence of gram-positive cocci with a constant progressive rise from 2001 till 2017. Such findings of the predominance of gram-positive bacteria were similar to studies conducted in Scotland, Canada, the United States of America, and Hong Kong in which gram-positive microorganisms comprised up to 66% of causative pathogens of peritonitis (19).…”