Incident elderly patients on peritoneal dialysis: Epidemiological characteristics and modality impact on survival time.

Aging of the population and the increased prevalence of diseases such as diabetes and arterial hypertension result in an increasing need of dialysis treatment. Herein we describe a cohort of elderly patients on peritoneal dialysis (PD) and assess the influence of the modality on the long-term survival. Out of a multicenter prospective cohort of 2,144 BRAZPD PD incident patients during a period from December 2004 to October 2007, 762 elderly adults, defined as patients ≥65-year-old, were eligible for the study, 413 started on automated PD (APD) and 349 on continuous ambulatory PD (CAPD). Patients were followed until death, transfer to hemodialysis, recovery of renal function, loss to follow-up, or transplantation. Demographics and clinical data were evaluated at baseline and described as mean ± standard deviation, median, or percentage. Competing risk and time-dependent Cox analysis were performed, having dialysis modality APD] vs. CAPD as a dependent variable, as hazard ratio (HR) is not proportional throughout the therapy time. Mean age was 74.5 ± 6.8 years in APD, 74.6 ± 6.7 in CAPD, 50.8% females in APD, 54.4% in CAPD. The frequently observed comorbidities were diabetes (52.3% in APD and 47% in CAPD) and left ventricular hypertrophy (36.3% in APD and 46.1% in CAPD) whereas 93.6% presented Davies score ≥2. In Cox time-dependent analysis, HR did not show difference up to 18 months HR = 1.11, confidence interval (CI) = 0.85-1.46], but thereafter, APD modality revealed lower risk of mortality (HR = 0.25, CI = 0.0073-0.86), when compared with CAPD. After adjustment for the confounding factors, CAPD presented a higher risk of mortality (HR = 4.50, CI = 1.29-15.64). No differences in survival were observed up to 18 months of therapy; however, beyond 18 months, APD modality was a protection factor.

The impact of continuous renal replacement therapy on renal outcomes in dialysis-requiring acute kidney injury may be related to the baseline kidney function.

BACKGROUND: Many controversies exist regarding the management of dialysis-requiring acute kidney injury (D-AKI). No clear evidence has shown that the choice of dialysis modality can change the survival rate or kidney function recovery of critically ill patients with D-AKI. METHODS: We conducted a retrospective study investigating patients (≥16 years old) admitted to an intensive care unit with D-AKI from 1999 to 2012. We analyzed D-AKI incidence, and outcomes, as well as the most commonly used dialysis modality over time. Outcomes were based on hospital mortality, renal function recovery (estimated glomerular filtration rate-eGFR), and the need for dialysis treatment at hospital discharge. RESULTS: In 1,493 patients with D-AKI, sepsis was the main cause of kidney injury (56.2%). The comparison between the three study periods, (1999-2003, 2004-2008, and 2009-2012) showed an increased in incidence of D-AKI (from 2.56 to 5.17%; p = 0.001), in the APACHE II score (from 20 to 26; p < 0.001), and in the use of continuous renal replacement therapy (CRRT) as initial dialysis modality choice (from 64.2 to 72.2%; p < 0.001). The mortality rate (53.9%) and dialysis dependence at hospital discharge (12.3%) remained unchanged over time. Individuals who recovered renal function (33.8%) showed that those who had initially undergone CRRT had a higher eGFR than those in the intermittent hemodialysis group (54.0 × 46.0 ml/min/1.73 m2, respectively; p = 0.014). In multivariate analysis, type of patient, sepsis-associated AKI and APACHE II score were associated to death. For each additional unit of the APACHE II score, the odds of death increased by 52%. The odds ratio of death for medical patients with sepsis-associated AKI was estimated to be 2.93 (1.81-4.75; p < 0.001). CONCLUSION: Our study showed that the incidence of D-AKI increased with illness severity, and the use of CRRT also increased over time. The improvement in renal outcomes observed in the CRRT group may be related to the better baseline kidney function, especially in the dialysis dependence patients at hospital discharge.

Automated Peritoneal Dialysis Is Associated with Better Survival Rates Compared to Continuous Ambulatory Peritoneal Dialysis: A Propensity Score Matching Analysis.

INTRODUCTION: The impact of peritoneal dialysis modality on patient survival and peritonitis rates is not fully understood, and no large-scale randomized clinical trial (RCT) is available. In the absence of a RCT, the use of an advanced matching procedure to reduce selection bias in large cohort studies may be the best approach. The aim of this study is to compare automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) according to peritonitis risk, technique failure and patient survival in a large nation-wide PD cohort. METHODS: This is a prospective cohort study that included all incident PD patients with at least 90 days of PD recruited in the BRAZPD study. All patients who were treated exclusively with either APD or CAPD were matched for 15 different covariates using a propensity score calculated with the nearest neighbor method. Clinical outcomes analyzed were overall mortality, technique failure and time to first peritonitis. For all analysis we also adjusted the curves for the presence of competing risks with the Fine and Gray analysis. RESULTS: After the matching procedure, 2,890 patients were included in the analysis (1,445 in each group). Baseline characteristics were similar for all covariates including: age, diabetes, BMI, Center-experience, coronary artery disease, cancer, literacy, hypertension, race, previous HD, gender, pre-dialysis care, family income, peripheral artery disease and year of starting PD. Mortality rate was higher in CAPD patients (SHR1.44 CI95%1.21-1.71) compared to APD, but no difference was observed for technique failure (SHR0.83 CI95%0.69-1.02) nor for time till the first peritonitis episode (SHR0.96 CI95%0.93-1.11). CONCLUSION: In the first large PD cohort study with groups balanced for several covariates using propensity score matching, PD modality was not associated with differences in neither time to first peritonitis nor in technique failure. Nevertheless, patient survival was significantly better in APD patients.

Outcomes of a peritoneal dialysis program in remote communities within Colombia.

BACKGROUND AND OBJECTIVE: Colombia is a country of diverse geographic regions, some with mountainous terrain that can make access to urban areas difficult for individuals who live in remote areas. In 2005, a program was initiated to establish remote peritoneal dialysis (PD) centers in Colombia to improve access to PD for patients with end-stage renal disease who face geographic or financial access barriers. PATIENTS AND METHODS: The present study was a multi-center cohort observational study of prevalent home PD patients who were at least 18 years of age and were being managed by one of nine established remote PD centers in Colombia over a 2-year period. Data were collected from clinical records, databases, and patient interviews. Patient survival, incidence of peritonitis, and rate of withdrawal from PD therapy were assessed. RESULTS: A total of 345 patients were eligible for the study. The majority (87.8%) of patients lived on one to two times a minimum monthly salary (equivalent to US$243 - US$486). On average, patients traveled 1.2 hours and 4.3 hours from their home to their remote PD center or an urban reference renal clinic, respectively. The incidence rate of peritonitis was 2.54 episodes per 100 patient-months of therapy. A bivariate analysis showed a significantly higher risk of peritonitis in patients who were living on less than one times a monthly minimum salary (p < 0.05) or who had a dirt, cement, or unfinished wood floor (p < 0.05). The 1-year and 2-year patient survival rates were 92.44% and 81.55%, respectively. The 1-year and 2-year technique survival rates were 97.27% and 89.78%, respectively. CONCLUSIONS: With the support of remote PD centers that mitigate geographic and financial barriers to healthcare, home PD therapy is a safe and appropriate treatment option for patients who live in remote areas in Colombia.

Family income and survival in Brazilian Peritoneal Dialysis Multicenter Study Patients (BRAZPD): time to revisit a myth?

BACKGROUND AND OBJECTIVES: Although low socioeconomic status has been considered a contraindication to peritoneal dialysis (PD), no published data clearly link it to poor outcomes. The goal of this study was assessing the effect of income on survival in the Brazilian Peritoneal Dialysis Multicenter STUDY. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Incident PD patients enrolled in this prospective cohort from December 2004 to October 2007 were divided according to monthly family income. The median age was 59 years, 54% were women, 60% Caucasians, 41% diabetics, and 24% had cardiovascular disease. Most of them were in continuous ambulatory PD, had not received predialysis care, had <4 school years, and had a family income of <5 minimum wage (80%). Survival analysis was performed using the Kaplan-Meier method and the Cox proportional hazards model adjusting the results for age, gender, educational status, predialysis care, first therapy, PD modality, calendar year, and comorbidities. RESULTS: There were no differences in technique (log rank test χ² = 4.36) and patient (log rank test χ² = 2.92) survival between the groups. In the multivariate analysis, low family income remained not associated either to worse technique survival (hazard ratio [HR] = 1.29; 95% confidence interval [CI] = 0.91 to 1.84) or to patient survival (HR = 1.40; 95% CI = 0.99 to 1.99). CONCLUSIONS: According to these results, economic status is not independently associated with outcomes in this large cohort and should not be considered a barrier for PD indication.

Health-related quality of life predicts outcomes but is not affected by peritoneal clearance: The ADEMEX trial.

BACKGROUND: We hypothesized that increasing small solute clearance in peritoneal dialysis (PD) would lead to improvements in patient health-related quality of life (HRQOL). METHODS: Patients were randomized to a control group [standard 4 x 2 L continuous ambulatory peritoneal dialysis (CAPD)] and an intervention group (CAPD with a target creatinine clearance >/=60 L/week/1.73 m(2)). The Kidney Disease Quality of Life Short Form was obtained at baseline and at 6, 12, and 24 months. Physical (PCS), mental (MCS), and kidney disease component summary (KDCS) scores were computed. RESULTS: The two groups were comparable at baseline with respect to HRQOL. Baseline variables highly predictive of better QOL included absence of diabetes, younger age, higher starting GFR, and serum albumin. Baseline values of QOL were highly predictive of survival and hospitalizations. An unadjusted comparison revealed that patients in the intervention group had significantly higher PCS and KDCS scores at six months. However, there were no significant differences between the intervention and control patients at 12 or 24 months. When similar analyses were carried out adjusting for different patterns of patient dropout, there were no significant differences between the two groups at any time point in terms of PCS, MCS, and KDCS scores. CONCLUSION: We found no evidence of a long-term benefit in HRQOL of CAPD patients by increasing peritoneal small-solute clearances when HRQOL parameters were adjusted for patient dropout. Measures of HRQOL have a significant predictive value for patient survival and hospitalizations.

Survival on chronic dialysis: 10 years' experience of a single Colombian center.

Using a retrospective cohort study, we evaluated survival and mortality risk factors in our dialysis population at the Renal Unit, RTS Cauca--Nephrologic San Jose, Popaydn, Cauca, Colombia. In the study, we included patients with chronic renal failure who started dialysis therapy during the period 1994-1999, and who remained on dialysis for a minimum of 5 years. Endpoints (living, died, lost to follow-up) were evaluated at the end of the study (July 2004), and a Kaplan-Meier survival analysis was performed. Mortality risk was analyzed using the multivariate Cox proportional hazard model. The study included 236 patients (129 on peritoneal dialysis and 107 on hemodialysis), whose mean age (+/- standard deviation) was 54.5 +/- 15.6 years. Of the group, 51% were women, 68.7% were urban dwellers, and 31.3% were rural dwellers. Major causes of end-stage renal disease included chronic glomerulonephritis (43.2%), diabetic nephropathy (35.7%), and hypertensive nephropathy (6.0%). The racial origins of the study population were half-caste (80.7%), Afro-Colombian (8.8%), indigenous (7.6%), and white (2.6%). Median (+ standard error) survival on hemodialysis was 66 +/- 10 months. Median survival on peritoneal dialysis was 57 +/- 7 months. Among patients with diabetes, median survival on hemodialysis was 40 +/- 13 months, and on peritoneal dialysis, it was 38 +/- 4 months. Major causes of mortality included sudden death (40%), infection (25%), and cardiovascular causes (22.5%). Significant mortality risk factors for hemodialysis patients were congestive heart failure (p = 0.01) and albumin <3 g/dL (p = 0.01). For peritoneal dialysis patients, the significant risk factors were diabetes mellitus (p = 0.01) and albumin < 2.5 g/dL (p = 0.02). Patient survival in our setting is similar to that reported in other series. The strongest predictive factors for mortality were diabetes mellitus, congestive heart failure, anemia, and hypoalbuminemia.

Peritoneal dialysis in the developing world: the Mexican scenario.

In the developing countries it is not possible to determine the total amount of money spent in the treatment of chronic diseases, and the practice of renal replacement therapies faces many obstacles. In Mexico, the introduction of continuous ambulatory peritoneal dialysis and continuous cycling peritoneal dialysis (CCPD) achieved very good results. Unfortunately, renal disease still affected as much as 95% of chronic renal failure patients and it became a disaster with an annual mortality rate higher than 60%. This was known as the Mexican Model which failed in establishing peritoneal dialysis as the only procedure for treating patients. In order to avoid a similar scenario with the 2 replacement therapies, we created the Official Norm for hemodialysis, and now we are experimenting with an increase from 5% to 20% of hemodialysis patients who are receiving therapy, principally in private units that attend Social Security patients. In addition, the government has established a Council for Transplantation that acts as a regulatory board. In other words, we are in the process of making chronic renal diseases a priority within the National Program.

Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis: ADEMEX, a prospective, randomized, controlled trial.

Small-solute clearance targets for peritoneal dialysis (PD) have been based on the tacit assumption that peritoneal and renal clearances are equivalent and therefore additive. Although several studies have established that patient survival is directly correlated with renal clearances, there have been no randomized, controlled, interventional trials examining the effects of increases in peritoneal small-solute clearances on patient survival. A prospective, randomized, controlled, clinical trial was performed to study the effects of increased peritoneal small-solute clearances on clinical outcomes among patients with end-stage renal disease who were being treated with PD. A total of 965 subjects were randomly assigned to the intervention or control group (in a 1:1 ratio). Subjects in the control group continued to receive their preexisting PD prescriptions, which consisted of four daily exchanges with 2 L of standard PD solution. The subjects in the intervention group were treated with a modified prescription, to achieve a peritoneal creatinine clearance (pCrCl) of 60 L/wk per 1.73 m(2). The primary endpoint was death. The minimal follow-up period was 2 yr. The study groups were similar with respect to demographic characteristics, causes of renal disease, prevalence of coexisting conditions, residual renal function, peritoneal clearances before intervention, hematocrit values, and multiple indicators of nutritional status. In the control group, peritoneal creatinine clearance (pCrCl) and peritoneal urea clearance (Kt/V) values remained constant for the duration of the study. In the intervention group, pCrCl and peritoneal Kt/V values predictably increased and remained separated from the values for the control group for the entire duration of the study (P < 0.01). Patient survival was similar for the control and intervention groups in an intent-to-treat analysis, with a relative risk of death (intervention/control) of 1.00 [95% confidence interval (CI), 0.80 to 1.24]. Overall, the control group exhibited a 1-yr survival of 85.5% (CI, 82.2 to 88.7%) and a 2-yr survival of 68.3% (CI, 64.2 to 72.9%). Similarly, the intervention group exhibited a 1-yr survival of 83.9% (CI, 80.6 to 87.2%) and a 2-yr survival of 69.3% (CI, 65.1 to 73.6%). An as-treated analysis revealed similar results (overall relative risk = 0.93; CI, 0.71 to 1.22; P = 0.6121). Mortality rates for the two groups remained similar even after adjustment for factors known to be associated with survival for patients undergoing PD (e.g., age, diabetes mellitus, serum albumin levels, normalized protein equivalent of total nitrogen appearance, and anuria). This study provides evidence that increases in peritoneal small-solute clearances within the range studied have a neutral effect on patient survival, even when the groups are stratified according to a variety of factors (age, diabetes mellitus, serum albumin levels, normalized protein equivalent of total nitrogen appearance, and anuria) known to affect survival. No clear survival advantage was obtained with increases in peritoneal small-solute clearances within the range achieved in this study.

Morbi-mortalidad en dialisis peritoneal continua ambulatoria. Experiencia con el uso de doble bolsa estudio multicentrico ISSSTE / Morbidity and mortality in continuous ambulatory peritoneal dialysis (CAPD). Experience with double bag. multicenter study (ISSSTE)

En el ISSSTE, el 80 por ciento de los pacientes con tratamiento sustitutivo de la función renal se encuentran en el Programa de Diálisis Peritoneal Continua Ambulatoria (DPCA). En el presente trabajo se analizan las causas más frecuentes de morbi-mortalidad de los pacientes del área metropolitana, Guadalajara y Monterrey, tratados con DPCA. De enero a Diciembre de 1999 se trataron 1021 pacientes. Al 31 de diciembre del mismo año sólo 661 permanecían dentro del programa. Los 360 restantes egresaron por causas diversas y de estas 259 fueron por fallecimiento, lo que representó el 25.1 por ciento del total. Durante el año 2000 se trataron 1439 pacientes de los cuales 344 fallecieron durante el año. Las complicaciones cardiovasculares constituyeron la mayor causa de morbi-mortalidad, promedio 50.1 por ciento durante los dos años, seguidas por las infecciones 14.2 por ciento y las metabólicas 9.6 por ciento. El índice de peritonitis observado fue de un episodio cada 26 meses paciente. Los problemas cardiovasculares son las causas más frecuentes de morbi-mortalidad en pacientes manejados con DPCA, dentro del ISSSTE.

Long-term CAPD survival and analysis of mortality risk factors: 12-year experience of a single Mexican center.

OBJECTIVE: To evaluate patient and technique survival, and to analyze mortality risk factors in a large Mexican single-center continuous ambulatory peritoneal dialysis (CAPD) program. DESIGN: Cohort study. SETTING: Tertiary care, teaching hospital located in Mexico City. PATIENTS: All patients from our CAPD program (1985-1997) were retrospectively studied. INTERVENTIONS: Clinical and biochemical variables at the start of dialysis were recorded and considered in the analysis of risk factors. MAIN OUTCOME MEASURES: End points were patient (alive, dead, or lost to follow-up) and technique status at the end of the study (December 1997). RESULTS: 627 patients, 37% with diabetes mellitus (DM), were included. Median patient survival (+/- SE) was 5.1 +/- 0.6 years. In the univariate analysis, the following variables were associated (p < 0.05) with mortality: DM, old age, hypoalbuminemia, low serum creatinine, low serum phosphate, and lymphopenia. In the multivariate analysis, the only significant mortality risk factors were DM (RR 2.56, p < 0.0001), old age (RR 1.01, p = 0.01), hypoalbuminemia (RR 0.77, p = 0.04), and lymphopenia (RR 0.98, p = 0.05). Median technique survival was 4.0 +/- 0.2 years. Peritonitis, hypoalbuminemia, lymphopenia, old age, and DM were all significantly associated (p < 0.05) with technique failure in the univariate analysis, while in the multivariate analysis, only DM (RR 1.78, p = 0.001), peritonitis (RR 1.13, p = 0.004), lymphopenia (0.98, p = 0.04), and hypoalbuminemia (RR 0.80, p = 0.06) were technique failure predictors. CONCLUSIONS: Patient survival in our setting is similar to that reported in other series. Diabetes mellitus, lymphopenia, and hypoalbuminemia were the strongest predictive factors for mortality and technique failure on CAPD. Our 12-year CAPD program is one of the largest single-centers reported in CAPD literature.

The problem of the high transporter: is survival decreased?

The mechanisms responsible for the problem status of high transporters are diverse. High transporters have increased protein losses that may play a role in the presence of hypoalbuminemia and malnutrition. On the other hand, high transport induces increased glucose absorption, which may in turn be responsible for anorexia and increased atherogenesis--issues not discussed here, but clearly of major importance. And finally, the impaired ultrafiltration present in the high transporter leads to fluid overload, which is one of the driving forces for ventricular hypertrophy, hypertension, and increased cardiovascular risk--cardiovascular events being most prevalent cause of death in dialysis patients. All of the factors previously discussed--and others--may preclude some high transporters from being good candidates for peritoneal dialysis. Yet many others may still do well if the prescription is individually tailored to the particular patient.

Is high peritoneal transport rate an independent risk factor for CAPD mortality?

UNLABELLED: Is high peritoneal transport rate an independent risk factor for CAPD mortality? BACKGROUND: Patients with high peritoneal transport display the lowest serum albumin (SAlb) and the highest peritoneal protein loss. An association between high peritoneal membrane permeability and diabetes mellitus (DM) has been suggested. As malnutrition, hypoalbuminemia, and DM cause high mortality, it is probable that a high peritoneal transport rate is associated with high mortality on continuous ambulatory peritoneal dialysis (CAPD). The aim of the study was to identify whether a high peritoneal transport rate is an independent risk factor for mortality on CAPD. METHODS: We included 167 patients with a peritoneal equilibration test that was performed between January 1994 and July 1997. The endpoint was the patient's status (alive, dead, or lost) in December 1997. Survival analysis was done by the Kaplan-Meier method and multivariate Cox proportional-hazard model. RESULTS: DM was significantly more frequent in the high (H) peritoneal transport type (20 out of 33) and was less frequent in the low (L) transport group (3 out of 18). SAlb (g/dL) was significantly lower as the peritoneal transport type was higher [H 2.7 +/- 0.5, high average (HA) 2.9 +/- 0.7, low average (LA) 3.2 +/- 0.6, and L 3.6 +/- 0.5]. Serum creatinine (SCr) was significantly higher in the L transport type (12.0 +/- 4.3 mg/dL) than in the other transport groups (H 8.7 +/- 3.1, HA 8.6 +/- 3.7, and LA 9.6 +/- 4.5). No other differences were found between peritoneal transport types. In the univariate analysis, high peritoneal transport rate, DM, low SCr, low SAlb, and older age significantly predicted mortality. However, in the multivariate analysis (chi2 = 40.55, P < 0.0001), only DM (b = 1.34, P = 0.0001), low SCr (b = -0.11, P = 0.02), and high peritoneal transport rate (b = 2.6, P = 0.06) were shown as mortality risk factors. CONCLUSIONS: DM was the most important risk factor for mortality on CAPD. A high peritoneal transport rate also predicted mortality, yet its role seems to be related to the presence of DM. The role of higher SCr predicting a better survival might have been associated with a better nutritional status. Hypoalbuminemia, previously shown as risk factor for mortality, did not play an important role in this study, probably because of its collinearity with DM.

CAPD in southern Brazil: an epidemiological study.

There are many studies on the performance of continuous ambulatory peritoneal dialysis (CAPD) in developed countries, but studies in the third world are scarce. The aim of this study is to analyze CAPD experience in the southernmost state of Brazil (Rio Grande do Sul, RS). Records were obtained from the Health Secretary of RS to assemble a cohort of all patients treated with CAPD. Another cohort study followed all patients initiating treatment for uremia in 1993 in the state capital, Porto Alegre, and compared CAPD, hemodialysis, and transplanted patients. In RS, 1316 patients (50.4% male, mean age 45.9 years) were treated in 40 CAPD programs. Despite the initial growth of the CAPD population, it subsequently leveled off. Survival was 78.6% and 40.7% in years 1 and 5, being worse for initial patients of each program, infants, and elders. Technique survival was 57.4% and 10.1% at years 1 and 5. Patients interrupting treatment for any reason had a higher chance of dropout. In Porto Alegre, 294 patients started dialysis during 1993; 21 performed CAPD, 44 had a transplant, and the others were hemodialyzed. Children were treated mostly by CAPD. CAPD patients had less diabetes and ischemic heart disease and received more transplants. Their adjusted actuarial survival (100% year 1; 67% year 3) was no different than hemodialysis. CAPD is not a popular form of renal therapy in RS, and dropout rates are significant.

Analísis de supervivencia actuarial de pacientes en dialísis / Actuarial survival analysis of patients in dialysis

The survival rate of our end stage renal disease (ESRD) population was calculated by means of actuarial survival curves. A total of 167 patients undergoing hemodialysis or CAPD during the 1977-1991 period were studied. They had been treated and closely followed for at least three months. Mean age for starting dialysis was 40.6 +/- 17 years; 107 (64) were males and 60 (36) females. Glomerulonephritis (25), diabetes (14) and nephroangiosclerosis (12) were the primary causes of ESRD. Survival rates were analysed by actuarial curves as designed by Kaplan and Meier. Statistical significance between curves was calculated with the Log Rank test. The level of significance considered was below 0.05. Multivariate analysis of survival was performed using the Cox proportional hazards regression model. Survival rates were in all cases expressed for the 1 degree, 5 degree and 10 degree year. They were for the whole group of 89, 63, and 38 respectively. When analysed according to their age: those under 30 years; between 30 and 50 and over 50 years old (at time to start dialysis); survival rates were of 97, 86, and 81 for the first group; 89, 66 and 29 for the second group, and 85, 44, and 10 for the third group. Significant differences were found between the first and second group (p < 0.025); the first and the third group (p < 0.001) and second and third group (p < 0.001) (Fig. 4).(ABSTRACT TRUNCATED AT 250 WORDS)

Analísis de supervivencia actuarial de pacientes en dialísis / Actuarial survival analysis of patients in dialysis

The survival rate of our end stage renal disease (ESRD) population was calculated by means of actuarial survival curves. A total of 167 patients undergoing hemodialysis or CAPD during the 1977-1991 period were studied. They had been treated and closely followed for at least three months. Mean age for starting dialysis was 40.6 +/- 17 years; 107 (64) were males and 60 (36) females. Glomerulonephritis (25), diabetes (14) and nephroangiosclerosis (12) were the primary causes of ESRD. Survival rates were analysed by actuarial curves as designed by Kaplan and Meier. Statistical significance between curves was calculated with the Log Rank test. The level of significance considered was below 0.05. Multivariate analysis of survival was performed using the Cox proportional hazards regression model. Survival rates were in all cases expressed for the 1 degree, 5 degree and 10 degree year. They were for the whole group of 89, 63, and 38 respectively. When analysed according to their age: those under 30 years; between 30 and 50 and over 50 years old (at time to start dialysis); survival rates were of 97, 86, and 81 for the first group; 89, 66 and 29 for the second group, and 85, 44, and 10 for the third group. Significant differences were found between the first and second group (p < 0.025); the first and the third group (p < 0.001) and second and third group (p < 0.001) (Fig. 4).(ABSTRACT TRUNCATED AT 250 WORDS)(Au)

La influencia de los episodios de peritonitis en un programa de diálisis peritoneal ambulatorio continua (DPAC)

La peritonitis sigue siendo la complicación más frecuente de la diálisis peritoneal ambulatoria continua (DPAC). 146 pacientes presentaron 224 episodios de perironitis durante el período de seguimiento de 3217 meses. En 105 de 212 episodios descritos se informó un cultivo positivo; en 51 se identificaron gérmenes Gram positivos (con mayor frecuencia Staphylococcus aureus), en 37 Gram negativos (Pseudomona aeruginosa más frecuente), en 11 casos dos gérmenes y en 6 casos hongos. Se obtuvo buen cubrimeinto contra Staphylococci. La respuesta inicial en los casos de peritonitis por Gram negativos sólo se observó en 48 por ciento de los casos. La probabilidad de desarrollar el primero, segundo, tercero y cuarto episodios de peritonitis fue de 89, 66, 41 y 23 por ciento respectivamente a los 36 meses de seguimineto. Se encontró que la peritonitis puede ser responsable de fallas en el método de tratamiento. El recuento leucocitario en el líquido de dializado no predijo la severidad de los episodios de peritonitis en el estudio. La administración de cefalotina como monoterapia en los casos asintomáticos y terapia combinada de cefalotina mas trobramicina en los sintomáticos permitieron una curación en 78 por ciento de los episodios. La ceftazidima es una buena alternativa para el manejo de las peritonitis por Gram negativos. Las observaciones que contribuyan a la prevención o curación de los casos de peritonitis en DPAC pueden ayudar a contrarestar el impacto negativo que las peritonitis ocasionan en estos programas.

[Actuarial survival analysis of patients in dialysis]. / Analísis de supervivencia actuarial de pacientes en dialísis.

The survival rate of our end stage renal disease (ESRD) population was calculated by means of actuarial survival curves. A total of 167 patients undergoing hemodialysis or CAPD during the 1977-1991 period were studied. They had been treated and closely followed for at least three months. Mean age for starting dialysis was 40.6 +/- 17 years; 107 (64%) were males and 60 (36%) females. Glomerulonephritis (25%), diabetes (14%) and nephroangiosclerosis (12%) were the primary causes of ESRD. Survival rates were analysed by actuarial curves as designed by Kaplan and Meier. Statistical significance between curves was calculated with the Log Rank test. The level of significance considered was below 0.05. Multivariate analysis of survival was performed using the Cox proportional hazards regression model. Survival rates were in all cases expressed for the 1 degree, 5 degree and 10 degree year. They were for the whole group of 89%, 63%, and 38% respectively. When analysed according to their age: those under 30 years; between 30 and 50 and over 50 years old (at time to start dialysis); survival rates were of 97%, 86%, and 81% for the first group; 89%, 66% and 29% for the second group, and 85%, 44%, and 10% for the third group. Significant differences were found between the first and second group (p < 0.025); the first and the third group (p < 0.001) and second and third group (p < 0.001) (Fig. 4).(ABSTRACT TRUNCATED AT 250 WORDS)