Peritoneal dialysis (PD) has been intensively offered at our centre to patients (pts) with end-stage renal disease (ESRD) from 2000, and the number of PD pts was noticed to raise. We aimed to analyse the PD population from the aspect of penetration and peritonitis rate during eleven years. Cumulative number of new RRT pts was 378 during the study period. We found high PD penetration rate: 53% (range 32–72%). The rate of peritonitis was as high as 9.8 during first study years, but it has declined progressively last year being 29.1 by September 2010 and 21.7 by December 2010. Most cases of peritonitis were due to gram-positive pathogens. We have demonstrated steady high single-centre PD penetration rate and improvement of management of patients during last decade probably because of the result of better pts education and a continued dedication of the staff.
Penetration of peritoneal dialysis varies widely across the world. It ranges from about 80% in Hong Kong and Mexico to few percentage points in the United States and some developing countries [
The report is based on retrospective data from patient's records, and comparable whole country data were obtained from Annual Report of Kidney Diseases 2009. PD penetration rate was defined as the percentage of new patients on PD in relation to all new dialysis patients each year. PD penetration rate, peritonitis rate, and microbiology of peritoneal fluid have been analysed for all pts in our program since 2000. In conjunction with epidemiological research study in the country, we recently expanded the data set where individual RRT patients data together with clinical performance indicators (CPI) at the end of each year have been collected and analyzed beside the basic RRT epidemiological data collection. In the current investigation, we demonstrate our single centre PD patients CPIs that characterize anaemia, calcium phosphate, and lipids mean patients group levels. The following biochemical parameters (using the Hitachi 912 Analyzer until 2004 and COBAS INTEGRA 800 after 204) were studied: serum creatinine (S-Crea,
The retrospective study was carried out at the Department of Internal Medicine of Tartu University. Cumulative number of new RRT patients in our centre who started peritoneal dialysis between January 2000 and December 2010 was 378. Mean age of all incidence dialysis patients was 58.8 years in 2010 with male predominance of 57%. Demographic data are comparable with country RRT incidence data showed in Annual Report of Kidney Diseases 2009. According to the Report, the mean age of incidence patients was 60.5 years, percentage of males 58%. Diabetes is the main cause of ESRD in new dialysis patients in Estonia [
Aetiology of chronic kidney disease in dialysis incident and prevalent patients at Tartu University Hospital during 2008–2010 and in Estonia in 2009.
Incident RRT pts at TUH, N (%) | Incident PD pts at TUH, N (%) | Prevalent PD patients in Estonia, N (%)* | Incident RRT pts at TUH, N (%) | Prevalent PD patients at TUH, N (%) | |||||
Diagnosis | 2010 | 2008 | 2009 | 2010 | 2008 | 2009 | 2010 | 2009 | 2009 |
Diabetes mellitus | 4 (14) | 4 (25) | 9 (33) | 1 (7) | 6 (22) | 13 (32) | 7 (20) | 30 | 24 (33) |
Hypertension | 5 (17) | 0 (0) | 5 (19) | 2 (14) | 4 (15) | 8 (20) | 5 (15) | 14 | 18 (25) |
Glomerulonephritis | 5 (17) | 2 (12) | 3 (11) | 2 (14) | 5 (19) | 6 (16) | 6 (18) | 13 | 6 (8) |
Chronic pyelonephritis | 7 (24) | 5 (32) | 4 (14) | 5 (37) | 6 (22) | 8 (20) | 8 (23) | 19 | 12 (16) |
Polycystic kidney disease | 2 (7) | 2 (12) | 1 (4) | 2 (14) | 3 (11) | 1 (2) | 2 (6) | 3 | 3 (4) |
Other | 6 (21) | 3 (19) | 5 (19) | 2 (14) | 3 (11) | 4 (10) | 6 (18) | 21 | 10 (14) |
*Data from Annual Report of Kidney Diseases in Estonia 2009.
Abbreviations: TUH, Tartu University Hospital; RRT, renal replacement therapy; PD, peritoneal dialysis; N, number.
Figure
Peritoneal dialysis penetration rate at the Tartu University Hospital 2000–2010.
Clinical and laboratory data are demonstrated in Table
Clinical and laboratory mean data in prevalent peritoneal dialysis patients group at the end of year 2010.
Variables | PD pts group mean | SD* | Min | Max |
---|---|---|---|---|
Patients total | ||||
BMI (kg/m2) | 28.8 | 1.1 | 19 | 43.6 |
Haemoglobin (g/L) | 113.4 | 2.6 | 94 | 157 |
S-creatinine ( | 705.5 | 45.6 | 316 | 1112 |
S-albumin (g/L) | 34.3 | 0.9 | 19 | 42 |
C-reactive protein (mg/L) | 9.5 | 1.5 | 1 | 32 |
S-ionized calcium (mmol/L) | 1.2 | 0.0 | 1.0. | 1.4 |
S-total calcium (mmol/L) | 2.4 | 0.0 | 1.7 | 2.8 |
S-phosphate (mmol/L) | 1.8 | 0.1 | 0.6 | 4.4 |
PTH (pmol/L) | 52.2 | 10.9 | 1.6 | 197 |
S-total cholesterol (mmol/L) | 5.7 | 0.2 | 3.0 | 7.8 |
S-HDL cholesterol (mmol/L) | 1.2 | 0.1 | 0.6 | 1.8 |
S-LDL cholesterol (mmol/L) | 3.9 | 0.2 | 1.9 | 6.2 |
S-triglycerides (mmol/L) | 1.9 | 0.2 | 0.8 | 5.4 |
*SD- standard deviation.
Arterial calcification is common in adults with chronic kidney disease and progresses with time. On the other hand, peritoneal calcification, one of the major complications, can develop in peritoneal dialysis patients [
Peritonitis remains a major complication in patients undergoing peritoneal dialysis and remains a major cause of patients discontinuing peritoneal dialysis and switching to haemodialysis. However, technique survival at year 1 has been almost 100% at our center during last years. Because of short period and small numbers survival, data are not included and will be shown separately. Our study analyzed peritonitis rate and pathogens responsible for the peritonitis. The incidence of peritoneal dialysis-related peritonitis was as high as 1 episode every 9.8 months in 2004, but it has progressively declined during the last years being 29.1 in September 2010 and 21.7 at the end of the year (Table
Peritonitis rate at Tartu University Hospital.
Year | 2004 | 2006 | 2008 | 2010* | 2010 |
---|---|---|---|---|---|
Pts total nr | 42 | 46 | 45 | 42 | 45 |
Pts nr at the end of the year | 29 | 34 | 27 | 35 | 34 |
Treatment months | 354 | 303 | 409 | 408 | 500 |
Peritonitis nr | 36 | 19 | 19 | 14 | 23 |
Peritonitis rate (episodes/nr pts-months) | 9.8 | 16 | 21.5 | 29.1 | 21.7 |
Peritonitis rate (episodes/pts-year) | 1.2 | 1.3 | 1.8 | 2.4 | 1.8 |
*January–September 2010.
The improvement that we noticed between 2004 and 2006 may be the result of change in the connection systems at that time. Currently, during last years, almost two thirds of patients were on Baxter DUO connection system and one third of patients remained on Fresenius stay-safe system.
Many centres have been reported that, over time, the microbiology at those institutions has been changing [
Etiology of peritonitis at Tartu University Hospital.
Pathogen | 2009-2010, | 2006-2007, |
---|---|---|
Coagulase-negative staphylococci | 21 | 15 |
11 | 10 | |
Streptococci | 2 | 6 |
Gram-positive rod-shaped bacteriae | 5 | 3 |
Enterococci | 4 | 2 |
Enterobacteria | 7 | 3 |
1 | 0 | |
0 | 1 | |
Yeasts | 2 (3%) | 0 |
Gram-positive organisms | 43 (74%) | 36 (84%) |
Gram-negative organisms | 8 (14%) | 4 (9%) |
Culture-negative peritonitis | 5 (9%) | 3 (7%) |
Total | 58 (100%) | 43 (100%) |
This is a first report on long-term peritoneal dialysis experience at a single centre in Estonia. We have demonstrated steady high single-centre peritoneal dialysis penetration rate and declining tendency of peritonitis rate after essential improvement of local skills.
The authors thank Maie Pikkmaa, Pirgit Palk, Siiri Mesikepp, Elviira Seppet, Eino Sinimäe, Külli Kõlvald, and Kristi Veermäe.