Achieving a Longer Duration of Peritoneal Dialysis Replacement Treatment in Patients with CKD

Abstract

INTRODUCTION: The International Society for Peritoneal Dialysis (ISPD) and the European Peritoneal Dialysis Association (EuroPD) recommend peritoneal dialysis (PD) as an initial replacement therapy for renal function due to a number of benefits of the method for both patients and the treatment team, health funds and society as a whole. It would be in everyone's interest to achieve a longer duration of PD treatment. For each dialysis center, the first step in this direction should be to identify the most common reasons for termination of PD. The next step is to develop a strategy to eliminate them or reduce their frequency based on the recommendations of the EuroPD and ISPD for best clinical practice in the field of PD.
AIM: The aim of this article is to analyze the reasons for discontinuation of treatment with PD and to outline opportunities for their elimination in order to achieve a longer duration of treatment with PD leading to longer overall life expectancy of patients. PATIENTS AND METHODS: During the period 01.01.2010–31.12.2019 patients were observed in the Clinic of Nephrology and Dialysis of the St. Marina University Hospital, Varna. The group consisted of 82 patients with CKD on replacement therapy with PD, aged 20 to 79 years—42 women and 40 men, with a duration of treatment of 3 to 108 months. The reasons for discontinuation of the PD treatment were analyzed. The EuroPD and ISPD recommendations for best clinical practice in the field of PD related to the targets are summarized.
RESULTS AND DISCUSSION: Of the 82 patients included in the study, as of December 31, 2019, 18 patients continue treatment with PD, 35 have switched to hemodialysis (HD), 8 have been transplanted, and 21 have died. The most common reason for transfer to HD is impaired peritoneal membrane function with reduced removal of waste products of protein metabolism and ultrafiltration (UF) deficiency. It is followed by peritonitis, catheter-associated infections and other reasons, incl. non-medical. The most common causes of death are cardiovascular complications—cerebrovascular disease (stroke), ischemic heart disease (heart attack), heart failure. Recurrent peritonitis and catheter-related infections are next in frequency. In some patients the cause of death remains unknown. Some of the reasons for stopping treatment could be eliminated, and for others it is probably possible to reduce their frequency.
CONCLUSION: In conclusion, in order to achieve a longer duration of treatment with PD, the efforts of the treatment team should be focused on 3 main areas: (1) preservation of peritoneal membrane function and its periodic examination for timely diagnosis of changes in it; (2) development and implementation of a strategy for prevention of peritonitis and catheter-related infections, and (3) monitoring and timely treatment of hypertension, hyperlipidemia, and hyperhydration as major risk factors for cardiovascular pathology.