Outcome of patients started on PD as
first line therapy,
Saira Usama, Jamal S. Alwakeel, Ahmad H. Mitwalli,
Abdulkareem Alsuwaida, Akram Askar,
King Khalid University Hospital ,
King Saud University, Riyadh, Saudi Arabia
Discussion
Results
Background
•The major goals in caring for patients with
end stage renal disease are
•to improve morbidity and mortality
•improve quality of life
•preserving residual renal function, and
reducing morbidity.
•The experience of many centers worldwide
have shown good results
•with peritoneal dialysis (PD)as first
line therapy,
•due to its simplicity, convenience, and
low cost.
PD as the first-choice modality for renal
replacement therapy has been shown to be
beneficial in many studies (1), with results
similar to our study
 A study by R Vanholder et al (2), showed
that PD as first line therapy has the
advantage of preservation of residual renal
function, and lower mortality rates
Percentage of patients in each group
PD FIRST
HD FIRST
51.94
PERITONITIS FREE INTERVAL
33.78
41.68
CONTINUING ON PD
23.08
TECHNIQUE FAILURE
TRANSPLANT
TIME ON PD
Pierre-Yves Durand, et al reported
improved patient survival compared with HD
patients during first 2 years of dialysis (3).
22.1
35.9
16.27
5.1
31.83
28.37
Objectives
• The mean time on PD was 31.83 (2 – 168
±30.197) months in the PD group, and 28.37 (2 –
92) months in the post HD group.
• The mortality in PD group was 13.9% (12
To assess complications and outcome of patients
patients) and 25.64 % (10 patients) in the post
started on peritoneal dialysis (PD) as initial dialysis
HD group.
therapy, compared to PD after Hemodialysis (HD).
• In PD group, 22.1% (19 patients) were shifted to
HD, due to technique failure compared to 35.9%
(21 patients) in the post HD group.
• 16.27 % (14 patients) underwent renal transplant
in PD group as compared to 5.1% (2 patients) in
 125 patients followed in the peritoneal dialysis unit
post HD group.
at King Khalid University Hospital, Riyadh, Saudi
• 4 patients were transferred to another center, in
Arabia
each group.
 during a 10 year period, between 2002 and 2011.
• In PD group, 41.86% (36 patients) were
 86 patients (M:F ratio, 41:45) were started on PD
continuing on PD at the end of the study
as the initial dialysis therapy. Mean age was 43.4
compared to 23.08 % (9 patients) in the post HD
(16 – 82 ± 19.3) years
group.
 39 patients ( M:F 15:24) were shifted to PD after
• In PD group, the peritonitis rate was one episode
having received regular Hemodialysis (POST HD).
every 51.94 patient months and 1 episode every
Mean age of the patients was 62.2 (21 – 86 ±
33.78 patient months in the post HD group
16.9) years.
Methods
1.
60
50
Causes of ESRD in both
groups (percentage)
2.
40
3.
30
20
4.
10
0
DIABETES GLOMER HYPERTE REFLUX NEPHROL URATE SOLITARY
MELLITUS ULONPHR NSION NEPHROP ITHIASIS NEPHROP KIDNEY
ITIS
ATHY
ATHY
PD FIRST 40.69
32.56
9.3
4.65
2.32
2.32
2.32
HD FIRST
56.4
17.9
15.38
0
2.56
0
0
OTHERS
5.81
7.62
5.
PD utilization can be increased by
implementing techniques to prevent and
minimize episodes of peritonitis, use of more
biocompatible solutions in preserving the
peritoneal membrane, and careful
management of volume status (4,5).
Patient and physician education and
comfort with using this modality are critical
in the success of initiative of PD first.
Conclusion
•Over a ten year period, patients started on
renal replacement therapy with PD showed
a better patient and technique survival
compared to patients initially on HD
•The patients in the PD group had
• longer time on PD ( p= 0.008),
•lower mortality(p= 0.01)
•fewer peritonitis episodes (p= 0.027).
•However this can be attributed to
differences in age and sample size.
References
Yiu-Wing Ho, Ka-Foon Chau, Development of the
“peritoneal dialysis first” model in hong kong Perit Dial Int
June 2007 27:S53-S55
R Vanholder, W Van Biesen, N Lameire The role of
peritoneal dialysis as the first-line renal replacement
modality Perit Dial Int 2000 Jul-Aug 20:375-383
Pierre-Yves Durand, Luc Frimat, Carole Loos-Ayav,
Impact Of First Dialysis Modality On Outcome Of Patients
Contraindicated For Kidney Transplant Perit Dial Int
March/April 2006 26:231-239
Shahab I, Khanna R, Nolph KD Peritoneal dialysis or
hemodialysis? A dilemma for the nephrologist.Adv Perit
Dial. 2006;22:180-5.
Wai-Kei LoPeritoneal dialysis utilization and outcome:
what are we facing? Perit Dial Int. 2007 Jun;27 Suppl
2:S42-7
This research was supported by King Saud University, Riyadh, Saudi Arabia