Kidney Res Clin Pract.  2021 Sep;40(3):472-483. 10.23876/j.krcp.21.020.

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

• Kang M
• Kim YL
• Kang E
• Ryu H
• Kim YC
• Kim DK
• Lee H
• Han SS
• Joo KW
• Kim YS
• Ahn C
• Oh KH

• KMID: 2524392
• DOI: http://doi.org/10.23876/j.krcp.21.020

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.

Keyword

Outcome; Peritoneal dialysis; Peritonitis; Survival; Technique survival