Complications and outcomes of urgent-start peritoneal dialysis in elderly patients with end-stage renal disease in China: a retrospective cohort study
Open Access
- 9 March 2020
- Vol. 10 (3), e032849
- https://doi.org/10.1136/bmjopen-2019-032849
Abstract
Objectives To investigate the complications and survival of elderly patients with end-stage renal disease (ESRD) who received urgent-start peritoneal dialysis (USPD) or urgent-start haemodialysis (USHD), and to explore the value of peritoneal dialysis (PD) as the emergent dialysis method for elderly patients with ESRD. Design Retrospective cohort study. Setting Two tertiary care hospitals in Shanghai, China. Participants Chinese patients (n=542) >65 years of age with estimated glomerular filtration rate ≤15 mL/min/m2 who received urgent-start dialysis between 1 January 2005 and 31 December 2015, and with at least 3 months of treatment. Patients who converted to other dialysis methods, regardless of the initial dialysis method, were excluded, as well as those with comorbidities that could significantly affect their dialysis outcomes. Primary and secondary outcome measures Dialysis-related complications and survival were compared. Patients were followed until death, stopped PD, transfer to other dialysis centres, loss to follow-up or 31 December 2016. Results There were 309 patients in the USPD group and 233 in the USHD group. The rate of dialysis-related complications within 30 days after catheter implantation was significantly lower in the USPD group compared with the USHD group (4.5% vs 10.7%, p=0.031). The 6-month and 1, 2 and 3-year survival rates were 95.3%, 91.4%, 86.6% and 64.8% in the USPD group, and 92.2%, 85.7%, 70.2% and 57.8% in the USHD group, respectively (p=0.023). The multivariable Cox regression analysis showed that USHD (HR=2.220, 95% CI 1.298 to 3.790; p=0.004), age (HR=1.025, 95% CI 1.013 to 1.043, pConclusions USPD was associated with slightly better survival compared with USHD. USPD was associated with fewer complications and better survival than USHD in elderly patients with ESRD.Keywords
Funding Information
- National Key Research and Development Program of China (2016YFC0901502)
- Shanghai Top Priority Key Clinical Disciplines Construction Project (2017ZZ02009)
- Shanghai Science and Technology Commission Foundation (15411971200)
- Shanghai Integration of Chinese and Western Medicine Foundation (SH201737)
This publication has 46 references indexed in Scilit:
- Prevalence of chronic kidney disease in China: a cross-sectional surveyThe Lancet, 2012
- Comparable outcome of acute unplanned peritoneal dialysis and haemodialysisNephrology Dialysis Transplantation, 2011
- Effects of comorbid and demographic factors on dialysis modality choice and related patient survival in EuropeNephrology Dialysis Transplantation, 2011
- Epidemiology, Surveillance, and Prevention of Bloodstream Infections in Hemodialysis PatientsAmerican Journal of Kidney Diseases, 2010
- Chronic Kidney Disease and End-Stage Renal Disease in the Elderly Population: Current Prevalence, Future Projections, and Clinical SignificanceAdvances in Chronic Kidney Disease, 2010
- Chronic Kidney Disease in Primary CareThe Journal of the American Board of Family Medicine, 2010
- Propensity-Matched Mortality Comparison of Incident Hemodialysis and Peritoneal Dialysis PatientsJournal of the American Society of Nephrology, 2010
- New Technologies in Peritoneal DialysisClinical Journal of the American Society of Nephrology, 2007
- Comparison of hemodialysis and peritoneal dialysis survival in The NetherlandsKidney International, 2007
- Mortality risks of peritoneal dialysis and hemodialysisAmerican Journal of Kidney Diseases, 1999