How has peritoneal dialysis changed over the last 30 years: experience of the Verona dialysis center

Abstract

Background: The last decade has witnessed considerable improvement in dialysis technology and changes in clinical management of patients in peritoneal dialysis (PD) with a significant impact on long term clinical outcomes. However, the identification of factors involved in this process is still not complete.

Methods: Therefore, to assess this objective, we retrospectively analyzed clinical records of 260 adult patients who started PD treatment from 1983 to 2012 in our renal unit. For the analysis, we divided them into three groups according to the time of starting dialysis: GROUP A (n: 62, 1983-1992), GROUP B (n: 66, 1993-2002) and GROUP C (n: 132, 2003 to 2012).

Results: Statistical analysis revealed that patients included in the GROUP C showed a reduction in mean patients' age (p = 0.03), smoking habit (p = 0.001), mean systolic blood pressure (p < 0.0001) and an increment in hemoglobin levels (p < 0.0001) and residual diuresis (p = 0.016) compared to the other two study groups. Additionally, patients included in GROUP C, mainly treated with automated peritoneal dialysis, showed a reduced risk of all-causes mortality and a decreased risk to develop acute myocardial infarction and cerebrovascular disease. Patients' age, diabetes mellitus and smoking habit were all positively associated with a significant increased risk of mortality in our PD patients, while serum albumin levels and residual diuresis were negatively correlated.

Conclusions: Therefore, the present study, revealed that in the last decade there has been a growth of our PD program with a concomitant modification of our patients' characteristics. These changes, together with the evident technical advances, have caused a significant improvement of patients' survival and a decrement of the rate of hospitalization. Moreover, it reveals that our pre-dialysis care, modifying the above-mentioned factors, has been a major cause of these clinical improvements.

Figure 1

Patients’ distribution according to peritoneal dialysis (PD) modalities and percentage of patients on the waiting list for renal transplantation in the three study periods. The histograms represent (A) the percentage of patients on CAPD: Continuous Ambulatory Peritoneal Dialysis or APD: automated peritoneal dialysis and (B) the percentage of PD patients on the waiting list for renal transplantation in the three study groups. Group A: 1983–1992; Group B: 1993–2002; Group C: 2003–2012. P values calculated by fisher exact test.

Figure 2

Multivariate Cox proportional hazard model for mortality according to several demographic and clinical characteristics. In this model are indicated Hazard ratio (HR) and 95% Coefficient interval (CI) for each factor analyzed. CVD: cardiovascular disease.

Figure 3

Survival rate in the three study groups by Kaplan-Meier. Survival rate of patients in the three study groups (Group A: 1983–1992, Group B: 1993–2002 and Group C: 2003–2012). Survival rate was better in Group C compared to the other two groups.

Figure 4

Incidence rate ratio of acute myocardial infarction (A), cerebrovascular disease (B) and vasculopathy (C) according to the three study groups. Group A: 1983–1992; Group B: 1993–2002; Group C: 2003–2012. Figure has been built on the basis of Cox analysis.

Figure 5

Days of hospitalization in the three study periods. The histograms represent the mean ± SD of the days of hospitalization for all causes (white bars) and peritonitis (gray bars) in each study group. Group A: 1983–1992; Group B: 1993–2002; Group C: 2003–2012.