Patient and technical survival and factors affecting mortality on peritoneal dialysis in King Narai hospital

Abstract

Renal replacement therapy using peritoneal dialysis is an effective treatment. There are increasing numbers of patients after Thailand approved the right for renal treatment therapy according to “PD first” policy.   We investigated patient and technique survival and factors affecting the mortality of PD patients at King-Narai hospital who were treated by peritoneal dialysis between Jan 1, 2009 and June 30, 2012.  This was a retrospective study. Incident 75 PD patients were included. The demographic, clinical, and biochemical data were collected in our renal database which has been established since January 2009. Primary outcomes were patient survival and technique survival at years 1, 2 and 3.  Secondary outcomes were to find out factors to be associated with mortality.  There were 75 PD patients were enrolled.  The average age of patients and mean blood pressure were 49.4±14.9 years and 103.3±10.3 mmHg respectively.   Fifty percent of patients had mean serum albumin ≥ 3.5 g/dL. Three most common causes of end-stage renal disease were unknown (40.0%), diabetes (38.7%) and glomerulonephritis (9.3%).    At the end of the study, there were 17(22.7%) deaths. 1(1.3%) patient received a kidney transplant, 8(10.7%) patients were transferred to hemodialysis. The estimation of technique survival including all causes of death as event by Kaplan-Meier at year 1, 2 and 3 was 88%, 77%, 67% respectively.  In addition, the estimation of patient survival by Kaplan-Meier at year 1, 2 and 3 was 88%, 80%, 72% respectively. Three factors contributed to survival were serum albumin less than 3.5 g/dL (RR: 5.9, p= 0.03), blood pressure less than 140/90 mmHg (RR: 0.12, p<0.01) and increasing age by 1 year (RR: 1.06, p=0.03).  PD related peritonitis accounted for 45% was the cause of treatment termination.   From this study, it can be concluded that King-Narai hospital had a satisfied outcomes of peritoneal dialysis treatments during the first 3.5 years. Early diagnosis and treatment of PD related peritonitis was important to improve technique survival. Hypoalbuminemia, lower arterial blood pressure  less than 140/90 mmHg and age were associated with higher mortality. However, further study needs to be carry on in order to investigate the relationship between arterial blood pressure and mortality of PD patients.