title: How has peritoneal dialysis changed over the last 30 years: experience of the Verona dialysis center.
abstract: BACKGROUND
  The last decade has witnessed considerable improvement in dialysis technology and changes in clinical management of patients in peritoneal dialysis (PD) with a significant impact on long term clinical outcomes. However, the identification of factors involved in this process is still not complete.
  
  
  METHODS
  Therefore, to assess this objective, we retrospectively analyzed clinical records of 260 adult patients who started PD treatment from 1983 to 2012 in our renal unit. For the analysis, we divided them into three groups according to the time of starting dialysis: GROUP A (n: 62, 1983-1992), GROUP B (n: 66, 1993-2002) and GROUP C (n: 132, 2003 to 2012).
  
  
  RESULTS
  Statistical analysis revealed that patients included in the GROUP C showed a reduction in mean patients' age (p = 0.03), smoking habit (p = 0.001), mean systolic blood pressure (p < 0.0001) and an increment in hemoglobin levels (p < 0.0001) and residual diuresis (p = 0.016) compared to the other two study groups. Additionally, patients included in GROUP C, mainly treated with automated peritoneal dialysis, showed a reduced risk of all-causes mortality and a decreased risk to develop acute myocardial infarction and cerebrovascular disease. Patients' age, diabetes mellitus and smoking habit were all positively associated with a significant increased risk of mortality in our PD patients, while serum albumin levels and residual diuresis were negatively correlated.
  
  
  CONCLUSIONS
  Therefore, the present study, revealed that in the last decade there has been a growth of our PD program with a concomitant modification of our patients' characteristics. These changes, together with the evident technical advances, have caused a significant improvement of patients' survival and a decrement of the rate of hospitalization. Moreover, it reveals that our pre-dialysis care, modifying the above-mentioned factors, has been a major cause of these clinical improvements.
authors.affiliation: Renal Unit, Department of Medicine, University-Hospital of Verona, Piazzale A. Stefani 1, 37126, Verona, VR, Italy. Gianluigi.zaza@univr.it.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Zaza
authors.affiliation: Renal Unit, Department of Medicine, University-Hospital of Verona, Piazzale A. Stefani 1, 37126, Verona, VR, Italy. carlo.rugiu@ospedaleuniverona.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Rugiu
authors.affiliation: Renal Unit, Department of Medicine, University-Hospital of Verona, Piazzale A. Stefani 1, 37126, Verona, VR, Italy. alessandra.trubian@yahoo.it.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Trubian
authors.affiliation: Renal Unit, Department of Medicine, University-Hospital of Verona, Piazzale A. Stefani 1, 37126, Verona, VR, Italy. simona.granata@univr.it.
authors.forename: Simona
authors.initials: S
authors.lastname: Granata
authors.affiliation: Department of Public Health and Community Medicine, University of Verona, Verona, Italy. albino.poli@univr.it.
authors.forename: Albino
authors.initials: A
authors.lastname: Poli
authors.affiliation: Renal Unit, Department of Medicine, University-Hospital of Verona, Piazzale A. Stefani 1, 37126, Verona, VR, Italy. antonio.lupo@univr.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Lupo
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D005260:Female; D006436:Hemodialysis Units, Hospital / Q000458:organization & administration; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000379:methods*; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects / Q000379:methods; D011379:Prognosis; D016016:Proportional Hazards Models; D058996:Quality Improvement; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome; D014505:Urban Population