Dr Ashik Hayat1
1Taranaki District Health Board, NewPlymouth, New Zealand
MD DM FRSCP FASN FACP MPH
Peritoneal dialysis (PD) is now the established and clinically equivalent therapy to hemodialysis, in patients with End Stage Kidney disease.
The aim of the present study is to analyze, the demographic and the clinical risk predictors of the death-censored technique failure and mortality in patients on PD in New Zealand.
Demographic and clinical data were collected from the New Zealand Peritoneal dialysis registry NZPDR from 1st January 1995 to 31st December 2014. Crude rates for technique failure and mortality were calculated. Cox proportional hazards regression model was generated to evaluate for the risk predictors of technique failure and mortality. Hazards of technique failure and mortality were compared between two decades of follow up, to examine for the time trends.
Of the 6379 patients studied, there were 2993 (46.9%) episodes of technique failure and 2684 (42%); deaths recorded over two decades of follow up. The crude death-censored technique failure rates were mean ± SD, of 165 ± (SD = 5.90) per 1000 patient years of the follow up. The mortality rates were mean ± SD, of 147.9 ± (SD= 5.50) per 1000 patient years of follow up. Two and 5-year death-censored technique survival rates were 67% and 17.5% respectively; while as the 2 and 5-year patient survival rates were 70.42% and 26% respectively. Crude rates and hazards of technique failure were lower in individuals older than 60 years, compared to younger individuals, with a HR of 0.72 (95% C.I. 0.67-0.79), p value <0.001. The Crude rates and the hazards of death in individuals older than 60 years were higher compared to younger individuals with a HR of 2.13, (95% CI 1.91-2.46), p value <0.001. Coiled catheters were associated with a higher technique failure rates, with a HR 1.26 (95% CI 1.16-1.37), p value, of <0.001. Larger centres were associated with a lower incidence of the death-censored technique failures, with HR 0.89, (95% CI 0.79-1.00), p value of 0.06. Technique failure and mortality rates were noted to be lower in the Asian and Pacifica ethnicities compared to European / Pakeha. Infections were the major causes (58.4%) of technique failure, with acute peritonitis contributing to 30.2%. Higher New Zealand deprivation index score, male gender, and non-Asian ethnicities were associated with poorer survival on PD.
Optimum management of the modifiable risk factors can improve the patient and technique survival on PD.
Consultant department of Nephrology Taranaki Base Hospital New Zealand