Predictors of Long-Term Survival on Peritoneal Dialysis in South India: A Multicenter Study

Abraham, Georgi; Kumar, Vishnu Charan Suresh; Nayak, K.S.; Rajan, Rajesh; Srinivasan, Geetha; Krishnamurthy, Magesh; Prasath, Arun; Kumar, Senthil P; Thandavan, Thiagarajan; Mathew, Milly; Lesley, Nancy

doi:10.3747/pdi.2008.00028

Cited by 21 publications

(32 citation statements)

References 16 publications

(19 reference statements)

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“…According to a recent publication there are 300 centers offering maintenance PD in India and the number of patients on PD has increased from 1,700 in 2001 to 6,500 in 2006 (5). There is a paucity of published data on the outcome of CAPD patients in India (4,6).…”

Section: Aintenance Peritoneal Dialysis (Pd) Especially Continuousmentioning

confidence: 99%

Long-Term Clinical Outcomes of Peritoneal Dialysis Patients: 9-Year Experience of a Single Center from North India

Vikrant

2014

Perit Dial Int

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♦ Objective: There is a paucity of published data on the outcome of maintenance peritoneal dialysis (PD) since the initiation of continuous ambulatory PD (CAPD) in India in 1991. The purpose of this study is to report long-term clinical outcomes of PD patients at a single center. ♦ Design: Retrospective study. ♦ Setting: A government-owned tertiary-care hospital in North India. ♦ Patients: Patients who were initiated on CAPD between October 2002 and June 2011, and who survived and/or had more than 6 months' follow-up on this treatment with last follow-up till December 31, 2011, were studied. ♦ Results: A total of 60 patients were included in the analysis. The mean age of the patients was 60.2 ± 9.2 years. The majority (65%) of the patients lived in rural areas. A high proportion (47%) were diabetic and 62% had ≥ 2 comorbidities. Total duration on peritoneal dialysis treatment was 1,773 patient-months (148 patient-years) with a mean duration of 29.6 ± 23 patient-months and median duration of 25 patient-months (range 6 -110 patient-months). Overall patient and technique survival at 1, 2, 3, 4 and 5 years was 77%, 53%, 25%, 15%, and 10% respectively. Patient survival of diabetics vs non-diabetics at 1, 2, 3, 4, and 5 years was 68% vs 84%, 54% vs 53%, 14% vs 34%, 11% vs 19%, and 11% vs 13%, respectively. The mortality in nondiabetics (16/32) was less than that in diabetic (18/28) patients (p = not significant). The main cause of mortality in these patients was cardiac followed by sepsis. There were 58 episodes of peritonitis. The rate of peritonitis was 1 episode per 30.6 patient-months or 0.39 episodes per patient-year. Furthermore, the total number of episodes of peritonitis and number of episodes of peritonitis per patient were higher in the non-survival group (p < 0.05). The incidence of tuberculosis (TB), herpes zoster (HZ) and hernias was 15%, 10% and 5% respectively. ♦ Conclusion: The study reports long-term outcomes of the PD patients, the majority of whom were elderly with a high burden of comorbidities. There was a high proportion of diabetics. The survival of diabetic vs non-diabetic and elderly vs non-elderly PD patients was similar in our study. The mortality in non-diabetics was less than that in diabetic patients. TB and HZ were common causes of morbidity. Peritonitis was associated with mortality in these patients.

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Section: Aintenance Peritoneal Dialysis (Pd) Especially Continuousmentioning

confidence: 99%

Long-Term Clinical Outcomes of Peritoneal Dialysis Patients: 9-Year Experience of a Single Center from North India

Vikrant

2014

Perit Dial Int

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“…Compared with patients in developed countries, patients in India initiating RRT have a different body size (25). The BMI has recently been validated for Asians, and different cut-off values have been used to define underweight, normal, overweight, and obese patients (26)(27)(28).…”

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confidence: 99%

Effect of Body Mass Index on Outcomes of Peritoneal Dialysis Patients in India

et al. 2014

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♦ Objectives: We studied the effect of body mass index (BMI) at peritoneal dialysis (PD) initiation on patient and technique survival and on peritonitis during follow-up. ♦ Methods: We followed 328 incident patients on PD (176 with diabetes; 242 men; mean age: 52.6 ± 12.6 years; mean BMI: 21.9 ± 3.8 kg/m 2 ) for 20.0 ± 14.3 months. Patients were categorized into four BMI groups: obese, ≥25 kg/m 2 ; overweight, 23 -24.9 kg/m 2 ; normal, 18.5 -22.9 kg/m 2 (reference category); and underweight, <18.5 kg/m 2 . The outcomes of interest were compared between the groups. ♦ Results: Of the 328 patients, 47 (14.3%) were underweight, 171 (52.1%) were normal weight, 53 (16.2%) were overweight, and 57 (17.4%) were obese at commencement of PD therapy. The crude hazard ratio (HR) for mortality (p = 0.004) and the HR adjusted for age, subjective global assessment, comorbidities, albumin, diabetes, and residual glomerular filtration rate (p = 0.02) were both significantly greater in the underweight group than in the normal-weight group. In comparison with the reference category, the HR for mortality was significantly greater for underweight PD patients with diabetes [2.7; 95% confidence interval (CI): 1.5 to 5.0; p = 0.002], but similar for all BMI categories of nondiabetic PD patients. Median patient survival was statistically inferior in underweight patients than in patients having a normal BMI. Median patient survival in underweight, normal, overweight, and obese patients was, respectively, 26 patient-months (95% CI: 20.9 to 31.0 patient-months), 50 patient-months (95% CI: 33.6 to 66.4 patient-months), 57.7 patient-months (95% CI: 33.2 to 82.2 patient-months), and 49 patientmonths (95% CI: 18.4 to 79.6 patient-months; p = 0.015). Death-censored technique survival was statistically similar in all BMI categories. In comparison with the reference category, the odds ratio for peritonitis occurrence was 1.8 (95% CI: 0.9 to 3.4; p = 0.086) for underweight patients; 1.7 (95% CI: 0.9 to 3.2; p = 0.091) for overweight patients; and 3.4 (95% CI: 1.8 to 6.4; p < 0.001) for obese patients. ♦ Conclusions: In our PD patients, mean BMI was within the normal range. The HR for mortality was significantly greater for underweight diabetic PD patients than for patients in the reference category. Death-censored technique survival was similar in all BMI categories. Obese patients had a greater risk of peritonitis.

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“…[2][3][4][5][6][7][8] But there are no clear-cut criteria for the diagnosis of hypovolemia or hypervolemia. Some patients have elevated systolic blood pressure, despite being euvolemic which is thought to be due to vascular stiffness.…”

Section: Discussionmentioning

confidence: 99%

“…For both the treatment modalities, international guidelines underline volume status for dialysis adequacy. 1 One of the main factors determining the morbidity and mortality in PD patients is volume status [2][3][4][5][6][7] and may even be more important than solute clearance. 8 Besides clinical findings (blood pressure, presence of edema, and weight gain), echocardiography, Dual Energy X-ray Absorptiometry (DEXA), direct measurement of extracellular and total body water (TBW), brain natriuretic peptide (BNP) has been used for the determination of hydration status.…”

Section: Introductionmentioning

confidence: 99%

Volume Status in Patients on Peritoneal Dialysis: The Role of Apelin and Bio-Impedance Spectroscopy

et al. 2012

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One of the main factors determining the survival of peritoneal dialysis (PD) patients is volume status. We aimed to investigate hydration status of PD patients by bio-impedance spectroscopy (BIS) and echocardiography and to study the relation of them with apelin, which has effects related with volume status like vasodilation, positive inotropism, and inhibition of ADH release and RAS antagonism. Chronic PD patients without active cardiac disease or clinically prominent hypervolemia were included. Besides the demographic, clinical, and laboratory data, BIS and echocardiographic findings together with apelin levels were recorded. The study included 21 patients. Of them, eight patients were euvolemic, one patient was hypovolemic, and others have some degree of overhydration (1.1-6.8 L) with BIS, although all were euvolemic clinically. Mean apelin level was 1.49 AE 0.49 ng/mL. Apelin level was positively correlated with ejection fraction and negatively with total body water (TBW), intracellular and extracellular water, lean tissue mass, and left atrium diameter. On linear regression model, TBW was the major determinant of apelin. Although apelin is expected to increase in hypervolemic patients, the negative correlation with body water in this study may be related with yet unknown role of apelin in dialyzed patients. They may have important roles in volume status in future.

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Predictors of Long-Term Survival on Peritoneal Dialysis in South India: A Multicenter Study

Cited by 21 publications

References 16 publications

Long-Term Clinical Outcomes of Peritoneal Dialysis Patients: 9-Year Experience of a Single Center from North India

Long-Term Clinical Outcomes of Peritoneal Dialysis Patients: 9-Year Experience of a Single Center from North India

Effect of Body Mass Index on Outcomes of Peritoneal Dialysis Patients in India

Volume Status in Patients on Peritoneal Dialysis: The Role of Apelin and Bio-Impedance Spectroscopy

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