Technique failure in peritoneal dialysis: Modifiable causes and patient-specific risk factors

Bonenkamp, Anna A; Sluijs, Anita van Eck van der; Dekker, Friedo W.; Struijk, Dirk G.; Fijter, Carola WH de; Vermeeren, Yolande M; Ittersum, Frans J. van; Verhaar, Marianne C.; Jaarsveld, Brigit C. van; Abrahams, Alferso C

doi:10.1177/08968608221077461

Cited by 16 publications

(21 citation statements)

References 48 publications

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“…It is worth mentioning, however, that all patients who stopped PD for psychosocial reasons in our study were men. Psychosocial reasons were the top cause of PD discontinuation in our data, which is different from what has been found in Australia/New Zealand, Netherlands, and France, where psychosocial factors played a smaller role compared to infectious and mechanical complications [27][28][29]. In our experience, patients' realization of the commitment needed to perform PD and lack of adequate family support were the main drivers of PD discontinuation, which could be traced to suboptimal patient and family education before initiating PD The two factors associated with an increased risk of death were lacking residual urine output at the time of PD initiation and not having PD as the rst treatment modality.…”

Section: Discussioncontrasting

confidence: 99%

Growing a Peritoneal Dialysis Program in Palestine from Zero to 178 Patients in 5 Years: A Single-Center Experience

Taher

Enaya

Sarsour

et al. 2023

Preprint

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Introduction: Kidney failure is rapidly rising in Palestine, as the number of patients receiving maintenance dialysis has quadrupled in the last 15 years. In this study, we share an overview of our experience growing a peritoneal dialysis (PD) program from zero to 178 patients in five years at An-Najah National University Hospital in Palestine, presenting some challenges and ways to overcome them. Methods: This was a single-center retrospective study of patients treated with PD from November 2016 to December 2021. Demographic and clinical data were obtained for each patient. In addition, PD discontinuation, peritonitis, and mortality rates were calculated and presented as the primary patient outcomes. Results: A total of 158 patients were eligible for the study. The mean age was 51.8 ± 16.4 years, and 53.8% of patients were male. Diabetic nephropathy was the most common cause of kidney failure. Sixty-three episodes of peritonitis were diagnosed in 48 patients (30.4%) for a rate of 1 episode/ 38.2 patient-months (0.31 episodes/ patient-years). Twenty patients had their PD treatment discontinued, mainly due to psychosocial reasons and infectious and mechanical complications. Death was the fate of 27 patients, with cardiovascular disease and COVID-19 being the two main causes. Conclusion: The outcomes of this experience proved favorable and showed that PD could serve as a viable option for kidney failure patients in Palestine. Moreover, this study can serve as an example for other places where circumstances are challenging to take the initiative of starting their PD programs.

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Section: Discussioncontrasting

confidence: 99%

Growing a Peritoneal Dialysis Program in Palestine from Zero to 178 Patients in 5 Years: A Single-Center Experience

Taher

Enaya

Sarsour

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

Section: Discussioncontrasting

confidence: 96%

Growing a peritoneal dialysis program in Palestine from zero to 178 patients in 5 years: a single-center experience

et al. 2023

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Introduction Kidney failure is rapidly rising in Palestine, as the number of patients receiving maintenance dialysis has quadrupled in the last 15 years. In this study, we share an overview of our experience growing a peritoneal dialysis (PD) program from zero to 178 patients in 5 years at An-Najah National University Hospital in Palestine, presenting some challenges and ways to overcome them. Methods This was a single-center retrospective study of patients treated with PD from November 2016 to December 2021. Demographic and clinical data were obtained for each patient. In addition, PD discontinuation, peritonitis, and mortality rates were calculated and presented as the primary patient outcomes. Results A total of 158 patients were eligible for the study. The mean age was 51.8 ± 16.4 years, and 53.8% of patients were male. Diabetic nephropathy was the most common cause of kidney failure. 63 episodes of peritonitis were diagnosed in 48 patients (30.4%) for a rate of 1 episode/ 38.2 patient-months (0.31 episodes/ patient-years). 20 patients had their PD treatment discontinued, mainly due to psychosocial reasons and infectious and mechanical complications. Death was the fate of 27 patients, with cardiovascular disease and COVID-19 being the two main causes. Conclusion The outcomes of this experience proved favorable and showed that PD could serve as a viable option for kidney failure patients in Palestine. Moreover, this study can serve as an example for other places where circumstances are challenging to take the initiative of starting their PD programs.

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“…Recent studies have found that the APD modality is associated with a reduced risk of technique failure compared to CAPD [ 13 , 15 , 16 ]. Therefore, elevated BMI and reduced serum albumin levels are also regarded as being predictors of peritoneal dialysis withdrawal and all-cause mortality [ 17 , 18 ], and diabetes, cardiovascular disease, and other complications appear to be risk factors for death or switching to HD [ 13 , 19 ]. Employment status and educational level may be different in people with and without technique failure [ 13 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Medical cure was defined as the complete resolution (culture of PD effluent was confirmed negative following appropriate treatment, with a PD effluent white cell count lower than 100/μL) together with a lack of the following complications: relapse/recurrent peritonitis, catheter removal, transfer to HD for ≥30 days, or death during the 30 days after onset of peritonitis episode [ 1 , 2 , 13 ]. Moreover, PD technique failure was defined as the transfer to in-center HD for greater than 30 days or PDRP-associated death, which was defined as death within 30 days of the onset of PDRP [ 1 , 2 , 13 ].…”

Section: Methodsmentioning

confidence: 99%

Technique failure in peritoneal dialysis-related peritonitis: risk factors and patient survival

Yü

Zhu

et al. 2023

Renal Failure

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Objective This study aimed to investigate the association between patient clinical characteristics and technique failure in peritoneal dialysis-related peritonitis (PDRP). The effect of peritonitis-associated technique failure on patient survival was also assessed. Methods Patients diagnosed with PDRP from January 1, 2010 to June 30, 2022 were retrospectively reviewed and analyzed. Relevant demographic, biochemical, and clinical data were collected. Univariate and multivariate logistic regression analyses were used to determine the predictors of peritonitis-associated technique failure in PD. Patients were divided into technique failure (F group) and nontechnique failure (NF group) groups. Patients were followed until death or until the date of Oct 1, 2022. Kaplan–Meier survival curves and landmark analysis were used to assess the survival of the PDRP cohort. Cox regression models were used to assess the association between potential risk factors and mortality. Results A total of 376 patients with 648 cases of PDRP were included in this study. Multivariate logistic regression analysis demonstrated that peritoneal dialysis (PD) duration (OR = 1.12 [1.03, 1.21], p = 0.005), dialysate WBC count on Day 3 after antibiotic therapy (OR = 1.41 [1.22, 1.64], p = 0.001), blood neutrophil-to-lymphocyte ratio (NLR) (OR = 1.83 [1.25, 2.70], p = 0.002), and serum lactate dehydrogenase (LDH) (OR = 4.13 [1.69, 10.11], p = 0.002) were independent predictors for technique failure in PDRP. Furthermore, serum high-density lipoprotein (HDL) (OR = 0.28 [0.13, 0.64], p = 0.002) was a protective factor against technique failure. According to the Kaplan–Meier analysis, patients experiencing peritonitis-associated technique failure had lower postperitonitis survival (log-rank = 4.326, p = 0.038). According to the landmark analysis, patients with a history of peritonitis-associated technical failures had a higher 8-year mortality after peritoneal dialysis. A Cox model adjusted for plausible predetermined confounders showed that technique failure was independently associated with all-cause mortality. Conclusions Dialysate WBC count on Day 3, PD duration, NLR, and LDH were independent risk factors for technique failure, whereas HDL was a protective factor. Peritonitis-associated technique failure had a higher risk of mortality and adverse effects on postperitonitis survival.

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Technique failure in peritoneal dialysis: Modifiable causes and patient-specific risk factors

Cited by 16 publications

References 48 publications

Growing a Peritoneal Dialysis Program in Palestine from Zero to 178 Patients in 5 Years: A Single-Center Experience

Growing a Peritoneal Dialysis Program in Palestine from Zero to 178 Patients in 5 Years: A Single-Center Experience

Growing a peritoneal dialysis program in Palestine from zero to 178 patients in 5 years: a single-center experience

Technique failure in peritoneal dialysis-related peritonitis: risk factors and patient survival

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