title: High rates of mortality and technique failure in peritoneal dialysis patients after critical illness.
abstract: BACKGROUND
  Little is known regarding the causes and outcomes of peritoneal dialysis (PD) patients admitted to the intensive care unit (ICU). We explored the outcomes of technique failure and mortality in a cohort of PD patients admitted to the ICU.
  
  
  METHODS
  Using a provincial database of 990 incident PD patients followed from January 1997 to June 2009, we identified 90 (9%) who were admitted to the ICU. Parametric and nonparametric tests were used as appropriate to determine differences in baseline characteristics. The Cox proportional hazards and competing risk methods were used to investigate associations.
  
  
  RESULTS
  Compared with other patients, those admitted to the ICU had been on PD longer (p < 0.0001) and were more often on continuous ambulatory PD (74.2% vs 25.8%, p = 0.016). Cardiac problems were the most common admitting diagnosis (50%), followed by sepsis (23%), with peritonitis accounting for 69% of the sepsis admissions. The 1-year mortality was 53.3%, with 12% alive and converted to hemodialysis, and one third remaining alive on PD. In multivariate Cox modeling, age [hazard ratio (HR): 1.01; 95% confidence interval (CI): 0.99 to 1.03], white blood cell count (HR: 1.02; 95% CI: 1.00 to 1.04), temperature (HR: 0.75; 95% CI: 0.61 to 0.92), and peritonitis (1.64; 95% CI: 1.21 to 2.22) at admission to the ICU were associated with the composite outcome of technique failure or death. In a competing risk analysis, the risk for death was 30%, and for technique failure, 36% at 1 year.
  
  
  CONCLUSIONS
  Patients on PD have high rates of death and technique failure after admission to the ICU.
authors: Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors: Ayaz
authors: A
authors: Khan
authors: Claudio
authors: C
authors: Rigatto
authors: Mauro
authors: M
authors: Verrelli
authors: Paul
authors: P
authors: Komenda
authors: Julie
authors: J
authors: Mojica
authors: Dan
authors: D
authors: Roberts
authors: Manish M
authors: MM
authors: Sood
mesh_terms: D016001:Confidence Intervals; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D017211:Treatment Failure