Impact of peritoneal dialysis strategy on technique and patient survival

Jose Emilio Sanchez; Catalina Ulloa; Carmen Merino Bueno; Elena Astudillo; Carmen Rodríguez-Suárez

doi:10.1093/ckj/sfad155

Impact of peritoneal dialysis strategy on technique and patient survival

Clin Kidney J. 2023 Jul 3;16(12):2523-2529. doi: 10.1093/ckj/sfad155. eCollection 2023 Dec.

Authors

Jose Emilio Sanchez¹, Catalina Ulloa², Carmen Merino Bueno¹, Elena Astudillo³, Carmen Rodríguez-Suárez³

Affiliations

¹ Hospital Universitario de Cabueñes, Department of Nephrology, Gijón, Spain.
² Fundación Hospital de Jove, Division of Nephrology, Gijón, Spain.
³ Hospital Universitario Central de Asturias, Department of Nephrology, Oviedo, Spain.

Abstract

Background: The aim of this study was to evaluate the impact of peritoneal dialysis (PD) strategy on technique and patient survival.

Methods: This was a retrospective, single-center study conducted on consecutive patients with chronic kidney disease who underwent PD between January 2009 and December 2019. The study sample was stratified into four different groups according to PD technique [automated (APD) or manual (CAPD)] and icodextrin use (yes versus no). The primary endpoints were survival of both technique and patient.

Results: A total of 531 patients were included in the analysis. Mean ± standard deviation age was 60.6 ± 14.6 years, 68.4% (363) were men and 34.8% (185) had diabetes. The median technique survival time was 19 (15) months. A total of 185 (34.8%), 96 (18.1%), 99 (18.7%) and 151 (28.4%) patients were included in the CAPD/No-Icodextrin, CAPD/Icodextrin, APD/No-Icodextrin and APD/Icodextrin study groups, respectively. Throughout the study, 180 (33.9%) patients underwent renal transplant, 71 (13.4%) were changed to hemodialysis and 151 (28.4%) died. Age [hazard ratio (HR) 0.975, 95% confidence interval (CI) 0.960-0.990, P = .001] and incidence of early peritoneal infection (HR 2.440, 95% CI 1.453-4.098, P = .001) were associated with technique survival, while age (HR 1.029, 95% CI 1.013-1.045, P < .001), Charlson Index (HR 1.192, 95% CI 1.097-1.295, P < 0.001), use of icodextrin (HR 0.421, 95% CI 0.247-0.710, P < .001) and APD/Icodextrin (HR 0.499, 95% CI 0.322-0.803, P = .005) were associated with patient survival.

Conclusions: Icodextrin use and APD/Icodextrin had a positive impact on patient survival, while older age and higher Charlson Index had a negative one. Age and incidence of early peritoneal infection significantly impacted on technique survival.

Keywords: chronic renal insufficiency; icodextrin; peritoneal dialysis; peritonitis; survival analysis.