Patient and technique survival and factors affecting mortality on peritoneal dialysis in Turkey: 12 years' experience in a single center.
BACKGROUND
We investigated patient and technique survival and factors affecting mortality in Turkish peritoneal dialysis (PD) patients.


METHODS
This was a retrospective study. 423 PD patients were included. The demographic, clinical, and biochemical data were collected from the medical records. Clinical outcomes were mortality and technique failure.


RESULTS
Mean age at the start of PD was 46.0 +/- 14.3 years and mean PD duration was 37.1 +/- 28.3 (median: 30, range: 4-137) months. Diabetes mellitus was the most common cause of end-stage renal disease (35.2%), followed by hypertension (14.7%). There were 89 (21.0%) deaths. 25 (5.9%) patients received a kidney transplant, 74 (17.4%) patients were transferred to hemodialysis. Estimation of technique survival by Kaplan-Meier was 96.1%, 83.2%, 67.6%, 45.8%, and 33.6% at 1, 3, 5, 8, and 10 years. Technique failure was associated with peritonitis rate [relative risk (RR): 3.22, p < 0.001] and peritoneal Kt/V urea (RR: 0.38, p = 0.001) in the Cox proportional hazards model analysis. Estimation of patient survival by Kaplan-Meier was 96.9%, 83.8%, 68.8%, 50.2%, and 40.7% at 1, 3, 5, 8, and 10 years, respectively. In the Cox proportional hazards model analysis, age (RR: 1.01, p = 0.05), transfer to PD from hemodialysis (RR: 1.84, p = 0.03), comorbid cardiovascular disease (RR: 1.90, p = 0.004), serum creatinine level (RR: 0.75, p < 0.001), total Kt/V urea (RR: 0.34, p < 0.001), peritonitis rate (RR: 1.87, p < 0.001), and dialysate-to-plasma creatinine ratio (RR: 6.49, p = 0.04) predicted mortality.


CONCLUSIONS
Even though we cannot conclude with certainty that survival rates in Turkish patients are better than those in the United States and Europe, our results seem to suggest this and warrant further studies adjusted for more extensive demographic features and comorbidities. The factors affecting mortality in Turkish PD patients are similar to other populations.
Sipahioglu
Murat Hayri
MH
Department of Nephrology, Medical Faculty, Erciyes University, Kayseri, Turkey. murathsipahioglu@yahoo.com
Aybal
Aysun
A
Unal
Aydin
A
Tokgoz
Bulent
B
Oymak
Oktay
O
Utas
Cengiz
C
D000328:Adult; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000097:blood / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000401:mortality*; D010538:Peritonitis / Q000209:etiology / Q000401:mortality*; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin; D016019:Survival Analysis; D014421:Turkey
D012709:Serum Albumin; D003404:Creatinine