Clinical features of patients treated by peritoneal dialysis for over a decade.

BACKGROUND: Peritoneal dialysis (PD) is well-established as renal replacement therapy in end stage renal disease and has survival rates similar or better than hemodialysis (HD) for the initial years on dialysis therapy. However retention rate is lower due to higher technique failure rates than in HD and few patients stay on PD for more than 10 years (PD>10 yrs ). Here we investigated clinical features characterizing PD>10 yrs patients.

PATIENTS AND METHODS: In a single center study of 450 prevalent PD patients, 35 PD>10 yrs patients (n=35) were compared with patients (n=415) who had been on PD for shorter periods of time in terms of clinical characteristics. Peritoneal transport, blood pressure, solute clearance, nutrition status, and blood calcium, phosphate and parathyroid hormone levels were measured dialysis start and, in PD>10 yrs patients, also after 5 and 10 years of PD.

RESULTS: The PD>10 yrs patients differed from the other PD patients in that (1) the proportion of women was higher; (2) body mass index (BMI) was lower; (3) there was no patient with diabetic nephropathy as primary diagnosis; (4) the incidence of peritonitis was lower; (5) glomerular filtration rate was higher; and (6) parathyroid hormone (PTH) levels were lower in those with decade-long PD treatment. In PD>10 yrs patients, serum albumin was maintained at a high level throughout the 10 year follow up; hemoglobin levels after 5 and 10 years of PD were higher than at the beginning of the treatment; blood calcium and phosphate concentrations were maintained at acceptable levels; while the dialysate/plasma ratio of creatinine, D/ P -value, increased during the decade-long PD treatment.

CONCLUSIONS: Patients receiving PD>10 years had lower incidence of peritonitis, lower BMI, adequate control of blood calcium and phosphate levels and solute clearance, and were more often women than PD patients treated for shorter periods of time.