Patient Survival and Factors Affecting Mortality on Automated Peritoneal Dialysis in Phra Nakhon Si Ayutthaya Hospital

Abstract

Objective: To study the survival rate and factors affecting mortality in end-stage renal disease patients undergoing automated peritoneal dialysis under the universal coverage scheme treated at Phra Nakhon Si Ayutthaya Hospital during June 1^st2021 – 30^thJune 2023. Methods: This was a retrospective cohort study by reviewing electronic medical records. Data was collected from end-stage renal disease patients on continuous ambulatory peritoneal dialysis (CAPD) who met the criteria for switching to APD treatment. Patients were then trained to use the automated peritoneal dialysis machine. Treatment was adjusted by determining dialysate volume and dwell cycles to achieve adequate peritoneal dialysis targets of weekly KT/V urea ≥1.7, CCr >45L/week/1.73 m2, and mean ultrafiltration >0.75L/day. Patient data and laboratory results were collected and analyzed statistically to determine survival rates and factors affecting mortality during June 1^st2021 - 30^thJune 2023. Results: There were 58 patients with a mean age of 56 years, predominantly female (51.7%). The causes of renal failure were diabetes mellitus 58.62%, unknown 18.96%, glomerulonephritis 10.34%. There were 3 HIV-positive patients and 1 pure red cell aplasia patient. The mean albumin was 3.36 ± 0.051 g/dL. Thirty-six percent were anuric patients. Follow-up showed 59.6% achieved weekly KT/V urea ≥1.7, mean CCr 42.5 ± 3.2 L/week/1.73 m2, mean ultrafiltration 0.78 ± 0.29 L/day. During the study period, 26 patients discontinued APD treatment, with 15 deaths (25.86%). The leading cause of death was cardiovascular disease (46.66%), followed by COVID-19 pneumonia (13.33%), and PD-related peritonitis (6.66%). Nine patients (15.51%) transitioned to hemodialysis. The 1-year and 2-year survival rates of APD patients at Phra Nakhon Si Ayutthaya Hospital were 68.8% and 59%, respectively. Conclusion: The 1-year and 2-year survival rates of APD patients at Phra Nakhon Si Ayutthaya Hospital during June 2021 - June 2023 were 68.8% and 59%, respectively. After controlling for other factors, patients with weekly KT/V urea <1.7 had a 3.37 times higher risk of mortality compared to those with weekly KT/V urea ≥1.7. Patients with treatment-resistant peritonitis had a 16.67 times higher risk of mortality compared to those without treatment-resistant peritonitis.