การศึกษาเปรียบเทียบผลการรักษาผู้ป่วยโรคไตเรื้อรังระยะสุดท้าย ที่ล้างไตทางช่องท้องต่อเนื่อง ระหว่างกลุ่มที่เคยและไม่เคยได้รับการฟอกเลือดด้วยเครื่องไตเทียมฉุกเฉินมาก่อน

Pimanong  Pooluea

Authors

Pimanong Pooluea Sawanpracharak Hospital

Keywords:

peritoneal dialysis, emergency hemodialysis, patient survival rate, technique survival, CAPD-related peritonitis

Abstract

Objective: This study aimed to compare treatment outcomes between the patients with ESRD who have undergone CAPD and CAPD following temporary hemodialysis. Comparing the treatment outcomes are patient survival rate, prognostic factors and cause of death, rate of technique failure, cause for technique failure, and incidence of CAPD-related peritonitis.

Setting: Peritoneal dialysis unit, Sawanpracharak Hospital

Design: Retrospective cohort study

Subjects: 295 ESRD patients at the peritoneal dialysis unit of Sawanpracharak Hospital from Jan 1, 2019, to Dec 31, 2021.

Methods: Medical records and dialysis records were reviewed. Age, gender, comorbidities, cause of ESRD, and causes of emergency hemodialysis were recorded as baseline data. Treatment outcome data were: date of insertion of Tenckhoff catheter, date of starting CAPD, date of technique failure, break-in period, date of CAPD-related peritonitis, prognostic factors and cause of death, and cause for technique failure. Participants were divided into groups of patients with ESRD who performed CAPD for the first time during the study period (CAPD group) and patients undergoing emergency hemodialysis before CAPD (CAPD-following HD group). Baseline data and treatment outcomes, including time to death, time to technique failure, prognostic factors and cause of death, and incidence of peritonitis, were analyzed by using Cox proportional hazard regression, Fine & Gray’s proportional sub-distribution hazard model, Kaplan-Meier plot, Fisher’s Exact test, risk regression, Hazard Ratio (HR) and 95% confidence interval (CI).

Results: The median follow-up time was 12 months, 156 patients in the CAPD groupand 139 patients in the CAPD-following HD group, overall baseline data of the two groups were not different, except that patients in the CAPD group had fewer comorbidities with cerebrovascular accidents (5.1% and 13.7%, P=0.01), and patient survival rate in the CAPD group and patients in the CAPD-following HD group were not statistically different (HR=1.08, 95%CI=0.64-1.83, P=0.76) and from the analysis using Competing risk regression, the cumulative death rate of patients in both groups were not statistically different (HR = 1.09, 95%CI=0.66-1.83, P=0.73). Technique survival of patients in both groups was not statistically different (HR = 0.97, 95%CI=0.54-1.75, P=0.92). Prognostic factors of death, it was found that patients older than 60 years had a 1.84 times significantly increased mortality rate (HR = 1.84, 95%CI = 1.06-3.18, p = 0.03), and patients with diabetes mellitus had a 2.05 times significantly increased mortality (HR=2.05, 95%CI=1.05-3.98, P=0.04). Finally, the incidence of CAPD-related peritonitis in the CAPD and CAPD-following HD groups was not significantly different (RR=0.90, 95%CI=0.68- 1.19, P=0.47).

Conclusion: Patient survival rate, technique survival, and CAPD-related peritonitis of patients in the CAPD group and CAPD-following HD group were not significantly different. Prognostic factors of death include being over 60 years of age and patients with comorbidities with diabetes.

Keywords: peritoneal dialysis, emergency hemodialysis, patient survival rate, technique survival, CAPD-related peritonitis

References

Ingsathit A, Thakkinstian A, Chaiprasert A, Sangthawan P, Gojaseni P, Kiattisunthorn K, et al. Prevalence and risk factors of chronic kidney disease in the Thai adult population: Thai SEEK study. Nephrol Dial Transplant. 2010;25(5):1567-75.

Chuasuwan A. LA. THAILAND RENAL REPLACEMENT THERAPY YEAR 2020. ข้อมูลการบําบัดทดแทนไตในประเทศไทย พศ 2563. 2020.

สำนักงานหลักประกันสุขภาพแห่งชาติ. การบริหารงบบริการผู้ป่วยไตวายเรื้อรัง. คู่มือบริหารกองทุนหลักประกันสุขภาพแห่งชาติ. 2558.

Tu YR, Tsai TY, Lin MS, Tu KH, Lee CC, Wu VC, et al. Association between initial dialytic modalities and the risks of mortality, infection death, and cardiovascular events: A nationwide population-based cohort study. Sci Rep. 2020;10(1):8066.

Li WY, Wang YC, Hwang SJ, Lin SH, Wu KD, Chen YM. Comparison of outcomes between emergent-start and planned-start peritoneal dialysis in incident ESRD patients: a prospective observational study. BMC Nephrol. 2017;18(1):359.

Parapiboon W, Sangsuk J, Nopsopon T, Pitsawong W, Tatiyanupanwong S, Kanjanabuch T, Johnson DW. Randomized Study of Urgent-Start Peritoneal Dialysis Versus Urgent-Start Temporary Hemodialysis in Patients Transitioning to Kidney Failure. Kidney Int Rep. 2022;7(8):1866-77.

Sipahioglu MH, Aybal A, Unal A, Tokgoz B, Oymak O, Utas C. Patient and technique survival and factors affecting mortality on peritoneal dialysis in Turkey: 12 years’ experience in a single center. Perit Dial Int. 2008;28(3):238-45.

Chieochanthanakij R. Twelve. Years CAPD Outcomes in Peritoneal Dialysis Unit of Sawanpracharak Hospital Sawanpracharak medical journal. 2019;20.

Changsirikulchai S, Sriprach S, Thokanit NS, Janma J, Chuengsaman P, Sirivongs D. Survival Analysis and Associated Factors in Thai Patients on Peritoneal Dialysis Under the PD-First Policy. Perit Dial Int. 2018;38(3):172-8.

Collins AJ, Foley RN, Chavers B, Gilbertson D, Herzog C, Johansen K, et al. ‘United States Renal Data System 2011 Annual Data Report: Atlas of chronic kidney disease & end-stage renal disease in the United States. Am J Kidney Dis. 2012;59(1 Suppl 1):A7, e1-420.

de Jager DJ, Grootendorst DC, Jager KJ, van Dijk PC, Tomas LM, Ansell D, et al. Cardiovascular and noncardiovascular mortality among patients starting dialysis. JAMA. 2009;302(16):1782-9.