Technique failure in peritoneal dialysis: Modifiable causes and patient-specific risk factors.

Autor:	Bonenkamp AA; Department of Nephrology, Amsterdam UMC, Vrije Universiteit Amsterdam, Research institute Amsterdam Cardiovascular Sciences, The Netherlands., van Eck van der Sluijs A; Department of Nephrology and Hypertension, University Medical Center Utrecht, The Netherlands., Dekker FW; Department of Clinical Epidemiology, Leiden University Medical Center, The Netherlands., Struijk DG; Department of Nephrology, Amsterdam UMC, University of Amsterdam, Research institute Amsterdam Cardiovascular Sciences, The Netherlands., de Fijter CW; Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands., Vermeeren YM; Department of Internal Medicine, Gelre Hospital, Apeldoorn, The Netherlands., van Ittersum FJ; Department of Nephrology, Amsterdam UMC, Vrije Universiteit Amsterdam, Research institute Amsterdam Cardiovascular Sciences, The Netherlands., Verhaar MC; Department of Nephrology and Hypertension, University Medical Center Utrecht, The Netherlands., van Jaarsveld BC; Department of Nephrology, Amsterdam UMC, Vrije Universiteit Amsterdam, Research institute Amsterdam Cardiovascular Sciences, The Netherlands.; Diapriva Dialysis Center, Amsterdam, The Netherlands., Abrahams AC; Department of Nephrology and Hypertension, University Medical Center Utrecht, The Netherlands.
Jazyk:	angličtina
Zdroj:	Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis [Perit Dial Int] 2023 Jan; Vol. 43 (1), pp. 73-83. Date of Electronic Publication: 2022 Feb 23.
DOI:	10.1177/08968608221077461
Abstrakt:	Background: Technique survival is a core outcome for peritoneal dialysis (PD), according to Standardized Outcomes in Nephrology-Peritoneal Dialysis. This study aimed to identify modifiable causes and risk factors of technique failure in a large Dutch cohort using standardised definitions. Methods: Patients who participated in the retrospective Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes cohort study and started PD between 2012 and 2016 were included and followed until 1 January 2017. The primary outcome was technique failure, defined as transfer to in-centre haemodialysis for ≥ 30 days or death. Death-censored technique failure was analysed as secondary outcome. Cox regression models and competing risk models were used to assess the association between potential risk factors and technique failure. Results: A total of 695 patients were included, of whom 318 experienced technique failure during follow-up. Technique failure rate in the first year was 29%, while the death-censored technique failure rate was 23%. Infections were the most common modifiable cause for technique failure, accounting for 20% of all causes during the entire follow-up. Leakage and catheter problems were important causes within the first 6 months of PD treatment (both accounting for 15%). APD use was associated with a lower risk of technique failure (hazard ratio 0.66, 95% confidence interval 0.53-0.83). Conclusion: Infections, leakage and catheter problems were important modifiable causes for technique failure. As the first-year death-censored technique failure rate remains high, future studies should focus on infection prevention and catheter access to improve technique survival.
Databáze:	MEDLINE
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