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Long-term clinical outcomes of peritoneal dialysis patients: single center experience from Korea

Authors
 Seung Hyeok Han  ;  Jung Eun Lee  ;  Dong Ki Kim  ;  Sung Jin Moon  ;  Hyun-Wook Kim  ;  Jae Hyun Chang  ;  Beom Seok Kim  ;  Shin-Wook Kang  ;  Kyu Hun Choi  ;  Ho Yung Lee  ;  Dae Suk Han 
Citation
 PERITONEAL DIALYSIS INTERNATIONAL, Vol.28(suppl 3) : 21-26, 2008 
Journal Title
 PERITONEAL DIALYSIS INTERNATIONAL 
ISSN
 0896-8608 
Issue Date
2008
MeSH
Adult ; Female ; Humans ; Kidney Failure, Chronic/mortality ; Kidney Failure, Chronic/therapy ; Korea/epidemiology ; Male ; Middle Aged ; Outcome Assessment (Health Care)* ; Peritoneal Dialysis, Continuous Ambulatory/mortality* ; Risk Factors ; Survival Rate/trends
Keywords
Continuous ambulatory peritoneal dialysis ; patient survival ; technique survival
Abstract
Of a large body of literature reporting clinical outcomes for patients maintained on peritoneal dialysis (PD), most publications have focused on relatively short-term results. Few reports have focused on long-term survival in PD patients. Here, we present our experience with long-term patient outcomes and further analyses of the trends in demographics and clinical outcomes of 2301 end-stage renal disease (ESRD) patients treated with continuous ambulatory PD (CAPD) during a 25-year period (1981 - 2005) at our institute. Outcomes were analyzed for 1656 patients, excluding those younger than 15 years of age at initiation of CAPD, those having less than 3 months' follow-up, or those who had been on hemodialysis or who received a kidney graft before starting CAPD. In the study patients, technique survival at 5 and 10 years was 71.9% and 48.1% respectively. Patient survival was 69.8% and 51.8%. Mean age at the start of PD (50.4 +/- 13.9 years vs. 44.2 +/- 13.9 years, p < 0.01), ESRD incidence as a result of diabetic nephropathy (30.5% vs. 19.5%, p < 0.01), and incidence of cardiovascular comorbidities (26.6% vs. 20.5%, p < 0.01) were all significantly greater in patients who started PD during the second half of the study period (1993 - 2005) as compared with the first half (1981 - 1992). A multivariate analysis adjusting for these changes in demographics and comorbid conditions revealed that PD therapy starting in 1993 - 2005 was associated with a significant reduction in technique failure [hazard ratio (HR): 0.65; p < 0.01] and mortality (HR: 0.68; p < 0.01) as compared with the earlier period. However, in subgroup analyses, technique survival was not observed to be significantly improved in patients with diabetes. In summary, technique and patient survival have significantly improved despite increases in patient age, cardiovascular comorbidity, and ESRD caused by diabetes. Although diabetes, older age, and cardiovascular comorbidities are not factors that are easily modifiable to improve PD outcomes, results at our institution are encouraging in an era of declining PD utilization.
Files in This Item:
T200800490.pdf Download
DOI
18552258
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Kim, Dong Ki(김동기)
Kim, Beom Seok(김범석) ORCID logo https://orcid.org/0000-0002-5732-2583
Kim, Hyun Wook(김현욱) ORCID logo https://orcid.org/0000-0002-4274-7562
Moon, Sung Jin(문성진)
Lee, Jung Eun(이정은) ORCID logo https://orcid.org/0000-0003-0917-2872
Lee, Ho Yung(이호영)
Chang, Jae Hyun(장제현)
Choi, Kyu Hun(최규헌) ORCID logo https://orcid.org/0000-0003-0095-9011
Han, Dae Suk(한대석)
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/106672
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