Effect of glomerular filtration rate at peritoneal dialysis initiation on clinical outcomes in Burapha Hospital
Keywords:
peritoneal dialysis, glomerular filtration rate, survival rate, peritonitisAbstract
Introduction The optimal time for peritoneal dialysis (PD) initiation remains controversial.
Objective To assess the correlation between eGFR at PD initiation and clinical outcomes.
The primary outcome was patient’s survival and the secondary outcomes were PD-related
complications and hospitalization.
Methods The patients who undergoing peritoneal dialysis in 2013-2017 were enrolled in this
retrospective study. Demographics, baseline laboratories, PD data and adequacy were collected
from the medical records. Patients were categorized into four groups < 3, 3-5.9, 6-9.9 and ≥10
ml/min/1.73 m2 as per eGFR at the initiation of PD for assessing the association with the clinical
outcomes.
Results 176 patients were included in this study. Female prevalence was 61.4%. Mean eGFR at
PD initiation was 5.35±2.60 ml/min/1.73m2, residual urine volume 736.53±502.5 ml/day, dialysis
vintage 26.32±19.42 months. Death occurred in 76 patients. The survival outcome was not
significantly different in any level of GFR at initiation (95% CI: 0.88-1.50; p=0.318). The peritonitis
rate and hospitalization were also similar (p=0.801, p=0.674 respectively).
Conclusion The late initiation of peritoneal dialysis showed comparable survival outcome
with the early initiation group, and did not increase the rate of peritonitis and hospitalization.
References
A. Early dialysis and renal transplantation.
Nephron. 1986; 44: 267-71.
2. Bonomini V, Vangelista A, Stefoni S. Early
dialysis in renal substitutive programs.
Kidney Int Suppl. 1978: S112-6.
3. NKF-DOQI clinical practice guidelines for
peritoneal dialysis adequacy. National
Kidney Foundation. Am J Kidney Dis. 1997;
30(3 Suppl 2): S67–136.
4. Saran R, Robinson B, Abbott KC, Bragg-
Gresham J, Chen X, Gipson D, et al. US
Renal Data System 2019 Annual Data
Report: epidemiology of kidney disease in
the United States. Am J Kidney Dis. 2019;
Oct 31. pii: S0272-6386(19)31009-1.
5. Jain AK, Sontrop JM, Perl J, Blake PG, Clark
WF, Moist LM Timing of peritoneal dialysis
initiation and mortality: analysis of the
Canadian Organ Replacement Registry. Am
J Kidney Dis. 2014; 63: 798–805.
6. Cooper BA, Branley P, Bulfone L. A
randomized, controlled trial of early
versus late initiation of dialysis. N Engl J
Med. 2010; 363: 609–19.
7. Tattersall J, Dekker F, Heimbürger O. Jager
KJ, Lameire N, Lindley E, et al. When to
start dialysis: updated guidance following
publication of the Initiating Dialysis Early
and Late (IDEAL) study. Nephrol Dial
Transplant. 2011; 26: 2082–6.
8. Andrassy KM, Comments on ‘KDIGO
2012 Clinical Practice Guideline for the
Evaluation and Management of Chronic
Kidney Disease’. Kidney Int. 2013; 84:
622–3.
9. Nesrallah GE, Mustafa RA, Clark WF, Bass A,
Barnich L, Hemmelgarn BR, et al. Canadian
Society of Nephrology 2014 clinical
practice guideline for timing the initiation
of chronic dialysis. CMAJ. 2014; 186: 112–7.
10. Adequacy of dialysis and nutrition in
continuous peritoneal dialysis association
with clinical outcomes. Canada-USA
(CANUSA) Peritoneal Dialysis Study Group.
J Am Soc Nephrol. 1996; 7: 198–207.
11. Tang SC, Ho YW, Tang AW, Cheng YY, Chiu
FH, Hong Kong Peritoneal Dialysis Study
Group. Delaying initiation of dialysis till
symptomatic uraemia–is it too late?
Nephrol Dial Transplant. 2007; 22: 1926–
32.
12. Shiao CC, Huang JW, Chien KL, Chuang
HF, Chen YM, Wu KD. Early initiation of
dialysis and late implantation of catheters
adversely affect outcomes of patients on
chronic peritoneal dialysis. Perit Dial Int.
2008; 28: 73-81.
13. Johnson DW, Wong MG, Cooper BA,
Branley P, Bulfone L, Collins JF, et al.
Effect of timing of dialysis commencement
on clinical outcomes of patients with
planned initiation of peritoneal dialysis
in the IDEAL trial. Perit Dial Int. 2012; 32:
595–604.
14. Oh KH, Hwang YH, Cho JH, Kim M, Ju KD,
Joo KW, et al. Outcome of early initiation
of peritoneal dialysis in patients with endstage
renal failure. J Korean Med Sci. 2012;
27: 170-6.
