Peritoneal dialysis in acute kidney injury: trends in the outcome across time periods

Peritoneal dialysis (PD) should be considered a suitable method of renal replacement therapy in acute kidney injury (AKI) patients. This study is the largest cohort providing patient characteristics, clinical practice, patterns and their relationship to outcomes in a developing country. Its objective was to describe the main determinants of patient and technique survival, including trends over time of PD treatment in AKI patients. This was a Brazilian prospective cohort study in which all adult AKI patients on PD were studied from January/2004 to January/2014. For comparison purposes, patients were divided into 2 groups according to the year of treatment: 2004-2008 and 2009-2014. Patient survival and technique failure (TF) were analyzed using the competing risk model of Fine and Gray. A total of 301 patients were included, 51 were transferred to hemodialysis (16.9%) during the study period. The main cause of TF was mechanical complication (47%) followed by peritonitis (41.2%). There was change in TF during the study period: compared to 2004-2008, patients treated at 2009-2014 had relative risk (RR) reduction of 0.86 (95% CI 0.77-0.96) and three independent risk factors were identified: period of treatment at 2009 and 2014, sepsis and age>65 years. There were 180 deaths (59.8%) during the study. Death was the leading cause of dropout (77.9% of all cases) mainly by sepsis (58.3%), followed cardiovascular disease (36.1%). The overall patient survival was 41% at 30 days. Patient survival improved along study periods: compared to 2004-2008, patients treated at 2009-2014 had a RR reduction of 0.87 (95% CI 0.79-0.98). The independent risk factors for mortality were sepsis, age>70 years, ATN-ISS > 0.65 and positive fluid balance. As conclusion, we observed an improvement in patient survival and TF along the years even after correction for several confounders and using a competing risk approach

Subdistribuition Hazard Ratio of Covariates for technique failure.

<p>Subdistribuition Hazard Ratio of Covariates for technique failure.</p

Probability of technique failure according to time period.

<p>Probability of technique failure according to time period.</p

Dropout causes according to time period.

<p>Dropout causes according to time period.</p

Prescription and metabolic and fluid control of acute kidney injury patient treated with high volume peritoneal dialysis according to time period.

<p>Prescription and metabolic and fluid control of acute kidney injury patient treated with high volume peritoneal dialysis according to time period.</p

Subdistribuition Hazard Ratio of Covariates for mortality.

<p>Subdistribuition Hazard Ratio of Covariates for mortality.</p

Acute kidney injury (AKI) patient outcome treated with high volume peritoneal dialysis.

<p>Acute kidney injury (AKI) patient outcome treated with high volume peritoneal dialysis.</p

Clinical data of acute kidney injury patient treated with high volume peritoneal dialysis according to time period of high volume peritoneal dialysis treatment.

<p>ICU: intensive care unit, i ATN: ischemic acute tubular necrosis, ATN-ISS: acute tubular necrosis individual severity score</p><p>* others: acidosis, more than one indication;</p><p>** others: liver diseases and post surgery;</p><p>*** others: nephrotoxic AKI, obstructive AKI and mixed AKI</p><p>Clinical data of acute kidney injury patient treated with high volume peritoneal dialysis according to time period of high volume peritoneal dialysis treatment.</p