Proper Estimated Glomerular Filtration Rate: eGFR in Peritoneal Dialysis Patients to Reduce Unplanned Hemodialysis in Inburi Hospital
Keywords:
Chronic kidney disease, estimated Glomerular Filtration Rate (eGFR), Peritoneal dialysis, Unplanned hemodialysisAbstract
Background: Chronic kidney disease (CKD) is a global health issue. At Inburi Hospital, a high incident of unplanned hemodialysis (unplanned HD) in CKD stage 5 patients who later received Tenckhoff (TK) catheter implantation for peritoneal dialysis (PD) was found. This study aimed to discover an appropriate eGFR cut point to initiate TK catheter implantation.
Methodology: The cross-sectional study was conducted in Inburi Hospital. Data of PD patients were collected from 1st February 2016 to 31st December 2022 and were analyzed to find difference of eGFR, laboratory measurements, and complications of CKD between the groups by using Chi-square, and T-test analysis. Cut point of eGFR was analyzed by using diagnostic test reflect sensitivity, specificity, and ROC area.
Result: 83 PD patients were divided into 37 unplanned HD and 46 planned PD patients. The patients in unplanned HD group had a significantly lower eGFR than the planned PD group (4.9 versus 6.8 ml/min/1.73 m2, p<0.001). Complications were found in the unplanned HD group. There was higher prevalence of uremia (67.9% vs. 10.9%, p<0.001), volume overload (56.8% vs. 17.4%, p<0.001), and acidosis (18.9% vs. 2.2%, p=0.01). In terms of appropriate eGFR cut-off values it was found that the optimal eGFR was 5.7 ml/min/1.73m2, sensitivity = 70.3%, specificity = 76.1%, area under the curve. (ROC area) = 0.73 (95%CI = 0.64 – 0.83), likelihood ratio (+) = 2.94, likelihood ratio (-) = 0.39, positive predictive value = 70.27% and negative predictive value = 76.09%.
Conclusion: Nephrologists should discuss with patients to initiate PD when eGFR decreases to 5.7 ml/min/1.73 m2 to reduce unplanned HD.
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