title: Effects of AA amyloidosis on survival in peritoneal dialysis.
abstract: BACKGROUND
  To investigate the effects of ESRD etiologies on mortality in peritoneal dialysis patients.
  
  
  METHODS
  We included patients who initiated therapy between 2001-2011 and classified them according to etiologies including amyloidosis, diabetes mellitus, chronic glomerulonephritis and polycistic renal disease. Socio-demographic data, clinical courses and infectious complications were compared between groups, and the reasons for peritoneal dialysis withdrawal were recorded. Patient and technique survival analysis were performed.
  
  
  RESULTS
  354 patients were included to the study. Thereafter, 154 patients were excluded. Totally, 29 patients with AA-amyloidosis (mean age 37.9±16.4 years, follow-up time 21.7±20.2 months), 78 patients with diabetes mellitus (mean age 56.9±13.6 years, follow-up time 35±28.6 months), 68 patients with chronic glomerulonephritis (mean age 37.2±12 years, follow-up time 47.7±29.9 months), 29 patients with polycystic renal disease (mean age 35.6±13.8 years, follow-up time 45.4±36.8 months) were evaluated. Albumin level was lower in patients with amyloidosis at initiation and the end of study (for both p<0.001). Incidence of peritonitis and catheter exit site/tunnel infection attacks were higher in patients with amyloidosis (p=0.002 and 0.018 respectively). There was statistical difference among groups with respect to the last status of patients (p<0.001). Deaths were frequent in amyloidotic and diabetic patients. The majority of deaths were due to peritonitis and/or sepsis and, cardiovascular reasons. The mortality rate was found higher in patients with amyloidosis (log rank=0.005), especially at first 2-3 years. Presence of anyone helping to administer peritoneal dialysis (OR:6.244, p=0,025), initial serum albumin level (OR:0.352, p=0,034) and presence of catheter exit site/tunnel infection(OR:0.250, p=0,015) were independent predictors of patient survival.
  
  
  CONCLUSIONS
  Renal failure etiology has effects on peritoneal dialysis patients' survival. Patients with amyloidosis have the worst survival. Because of loss of PD survival advantage seen in first years of therapy in patients with amyloidosis, peritoneal dialysis may not be suitable as first choice therapy in this group.
authors.affiliation: Department of Nephrology, Sisli Etfal Research and Educational Hospital, Istanbul-Turkey. dryenerkoc@yahoo.com
authors.forename: Yener
authors.initials: Y
authors.lastname: Koc
authors.forename: Taner
authors.initials: T
authors.lastname: Basturk
authors.forename: Abdulkadir
authors.initials: A
authors.lastname: Unsal
authors.forename: Tamer
authors.initials: T
authors.lastname: Sakaci
authors.forename: Elbis
authors.initials: E
authors.lastname: Ahbap
authors.forename: Ayse
authors.initials: A
authors.lastname: Sinangil
authors.forename: Sennur Kose
authors.initials: SK
authors.lastname: Budak
authors.forename: Mustafa
authors.initials: M
authors.lastname: Sevinc
authors.forename: Arzu Ozdemir
authors.initials: AO
authors.lastname: Kayalar
authors.forename: Baris
authors.initials: B
authors.lastname: Doner
mesh_terms: D000328:Adult; D000368:Aged; D000686:Amyloidosis / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D005921:Glomerulonephritis / Q000150:complications; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D007690:Polycystic Kidney Diseases / Q000150:complications; D012189:Retrospective Studies; D015996:Survival Rate