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Current status of peritoneal dialysis in Korea: efforts to achieve optimal outcome

Authors
 DS Han  ;  JH Hwang  ;  DH Kang  ;  HY Song  ;  H Noh  ;  SK Shin  ;  SW Lee  ;  SW Kang  ;  KH Choi  ;  SK Ha  ;  HY Lee 
Citation
 PERITONEAL DIALYSIS INTERNATIONAL, Vol.19(Suppl. 3) : 17-25, 1999 
Journal Title
 PERITONEAL DIALYSIS INTERNATIONAL 
ISSN
 0896-8608 
Issue Date
1999
MeSH
Cause of Death ; Dialysis Solutions/therapeutic use ; Humans ; Kidney Failure, Chronic/mortality ; Kidney Failure, Chronic/therapy ; Kidney Function Tests ; Kidney Transplantation ; Korea/epidemiology ; Peritoneal Dialysis/adverse effects ; Peritoneal Dialysis/mortality ; Peritoneal Dialysis/statistics & numerical data* ; Peritoneal Dialysis, Continuous Ambulatory/adverse effects ; Peritoneal Dialysis, Continuous Ambulatory/mortality ; Peritoneal Dialysis, Continuous Ambulatory/statistics & numerical data ; Peritonitis/etiology ; Peritonitis/prevention & control ; Renal Dialysis/standards ; Survival Analysis
Abstract
Since its introduction in 1981, peritoneal dialysis (PD) has become firmly established as an effective mode of renal replacement therapy and serves an increasing patient population in Korea. The latest registry data indicate that about 3700 end-stage renal disease patients are maintained on chronic PD, representing 24.1% of the country's dialysis population. The majority (93.3%) of these patients are on continuous ambulatory peritoneal dialysis (CAPD) using the two-bag disconnect system, while only 3.3% are on automated PD. Under current renal reimbursement policies, most dialysis patients have to pay 20% of dialysis fees. Thus CAPD patients on 4 x 2-L daily exchanges pay about US$200 per month, not including medication and travel costs. Traditionally, most PD centers in Korea have used the "standard" prescription of 4 exchanges of 2 L of solution for most of their patients. A recent survey of 1467 patients who commenced CAPD in 1997 revealed that 84% of these patients were initially prescribed 4 x 2-L exchanges, while 12% were given a daily volume of 6 L. With this standard prescription, the percentages of Korean CAPD patients initially achieving the adequacy target of Kt/V urea > or = 2.0 and standardized creatinine clearance (SCCr) > or = 60 L/week/1.73 m2, were 74.4% and 82.1%, respectively. It is likely that, among current Korean CAPD patients, a much lower percentage will achieve the clearance targets compared to this initial outcome, but the precise data are not available. However, it is not clear whether the levels of small-solute clearance recommended for optimal PD outcomes, and proposed by the NKF-DOQI guidelines, will bring the expected benefits to Korean patients. Overall survival of Korean PD patients appears to be as good as, or even better than, that in most other countries. Recently, a single large PD center reported patient survival of 92.1%, 85.6%, 81.4%, and 67.6% at 1, 2, 3, and 5 years respectively. Other centers also reported similar outcomes. As in other countries, cardiovascular deaths predominate among Korean patients: death was due to cardiac causes in 29%, to vascular causes in 21%, and to infectious causes in 24%. Peritonitis is the most important barrier to prolonged use of CAPD in Korea, and more PD patients transfer to hemodialysis because of peritonitis than in other countries. To further reduce the morbidity and mortality of Korean PD patients, various control measures need to be implemented that can reduce or prevent peritonitis and other infectious complications. Also, to further improve long-term patient outcome, Korean nephrologists need to establish and practice optimal clearance targets in the chronic care of these patients.
Full Text
http://www.pdiconnect.com/content/19/Suppl_3/S17.abstract
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
Han, Dae Suk(한대석)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/173799
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