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. 2021 Sep;40(3):472-483.
doi: 10.23876/j.krcp.21.020. Epub 2021 Jul 1.

Evolving outcomes of peritoneal dialysis: secular trends at a single large center over three decades

Minjung Kang  1   2 , Yae Lim Kim  3 , Eunjeong Kang  4 , Hyunjin Ryu  1 , Yong Chul Kim  1   2 , Dong Ki Kim  1   2 , Hajeong Lee  1   2 , Seung Seok Han  1   2 , Kwon-Wook Joo  1   2 , Yon Su Kim  1   2 , Curie Ahn  1   2 , Kook-Hwan Oh  1   2
Affiliations

Evolving outcomes of peritoneal dialysis: secular trends at a single large center over three decades

Minjung Kang et al. Kidney Res Clin Pract. 2021 Sep.

Abstract

Background: Peritoneal dialysis (PD) is improving as a renal replacement therapy for end-stage renal disease (ESRD) patients. We analyzed the main outcomes of PD over the last three decades at a single large-scale PD center with an established high-quality care system.

Methods: As a retrospective cohort study, we included participants (n = 1,203) who began PD between 1990 and 2019. Major PD-related outcomes were compared among the three 10-year cohorts.

Results: The 1,203 participants were 58.3% male with a mean age of 47.9 ± 13.8 years. The median PD treatment duration was 45 months (interquartile range, 19-77 months); 362 patients (30.1%) transferred to hemodialysis, 289 (24.0%) received kidney transplants, and 224 (18.6%) died. Overall, the 5- and 8-year adjust patient survival rates were 64% and 49%, respectively. Common causes of death included infection (n = 55), cardiac (n = 38), and cerebrovascular (n = 17) events. The 5- and 8-year technique survival rates were 77% and 62%, respectively, with common causes of technique failure being infection (42.3%) and solute/water clearance problems (22.7%). The 5-year patient survival significantly improved over time (64% for the 1990-1999 cohort vs. 93% for the 2010-2019 cohort). The peritonitis rate also substantially decreased over time, from 0.278 episodes/patient-year (2000-2004) to 0.162 episodes/patient-year (2015-2019).

Conclusion: PD is an effective treatment option for ESRD patients. There was a substantial improvement in the patient survival and peritonitis rates over time. Establishing adequate infrastructure and an effective system for high-quality PD therapy may be warranted to improve PD outcomes.

Keywords: Peritoneal dialysis; Peritonitis; Survival; Technique failure.

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Conflict of interest statement

Conflict of interest

Kook-Hwan Oh reports grants from Fresenius Medical Care, Korea and Baxter, Korea. The other authors have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.. Flowsheet of the patient selection process for analysis.
HD, hemodialysis; PD, peritoneal dialysis.
Figure 2.
Figure 2.. Survival rates by cohort.
(A) The crude patient survival rate. (B) The adjusted patient survival rate. (C) The crude technical survival rate. (D) The adjusted technical survival rate. The adjusted survival rate was adjusted for age, sex, and diabetes mellitus status.
Figure 3.
Figure 3.. Stratified subgroup analysis for the risk of all-cause death for the 2010–2019 vs. the 1990–1999 cohort.
For the Davies comorbidity score, ‘0’ denotes low risk, while ‘>0’ denotes a medium or high risk.
Figure 4.
Figure 4.. Temporal trends in the incidence of peritonitis.
(A) The overall incidence of peritonitis. (B) The cause-specific incidence of peritonitis. CNS, coagulase-negative Staphylococci; E. coli, Escherichia coli; GNB, gram-negative bacteria; S. aureus, Staphylococcus aureus; strep, Streptococcus.
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