Diaz-Buxo J, Shultman DS
Characteristics of long-term peritoneal dialysis patients
17th Annual CAPD Conference
Perit Dial Int Suppl 1
(Feb) 17:S59 1997
In every PD programme, only a few patients remain on PD for more than
5 years - why is this? One can only answer that question by
examining the causes of "drop-out". This abstract tries to define
the characteristics of the "survivors", in a retrospective analysis
from 743 patients trained in one center between Jan 1983 and Dec 1991.
The stated aim is improve patient selection and stimulate therapy
enhancement.
22 patients (3%) were found who had "survived" on PD for more than 5
years. Their mean age was 41 years, 59% male and 55% white. The
causes of ESRD were diabetes 31.8%, glomerulosclerosis 36.4%,
nephrosclerosis 22.7%. Average peritonitis rate 0.46 episodes/year
and hospitalisation 4 days/year. All patients were essentially
anuric after 3 years on PD. The majority had good social support and
were compliant with therapy.
Comment: Unfortunately, no data are presented with which to compare
these patients, so one cannot tell what the reason for their
long-term survival was. Without additional data on the other
712 "drop-outs", or at least a representative sample, the utility of
this presented data is very limited. In their conclusion the authors
describe the survivors as "of average size, enjoy stable and average
peritoneal transport, good social support, remain compliant with
therapy and experience infrequent peritonitis" but give us no clue as
to which of these factors mark them out from the rest.
The authors go on to say that "New PD modalities capable of
delivering higher doses and adjustment of prescription based on
residual function, peritoneal transport and metabolic needs should
increase the proportion of long-term survivors". Where's the evidence??
If one can show that the "drop-outs" were less well dialysed AND
dropped out as a result then I would agree, but otherwise surely
this is an unfounded conclusion?
(Alastair J. Hutchinson, M.D., The Royal Infirmary, Manchester,
UK)
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17th Annual CAPD Conference
CRF: Problem Areas :
Outcomes (Morbidity, Mortality)