title: Peritoneal Dialysis in Acute Kidney Injury: Trends in the Outcome across Time Periods.
abstract: Peritoneal dialysis (PD) should be considered a suitable method of renal replacement therapy in acute kidney injury (AKI) patients. This study is the largest cohort providing patient characteristics, clinical practice, patterns and their relationship to outcomes in a developing country. Its objective was to describe the main determinants of patient and technique survival, including trends over time of PD treatment in AKI patients. This was a Brazilian prospective cohort study in which all adult AKI patients on PD were studied from January/2004 to January/2014. For comparison purposes, patients were divided into 2 groups according to the year of treatment: 2004-2008 and 2009-2014. Patient survival and technique failure (TF) were analyzed using the competing risk model of Fine and Gray. A total of 301 patients were included, 51 were transferred to hemodialysis (16.9%) during the study period. The main cause of TF was mechanical complication (47%) followed by peritonitis (41.2%). There was change in TF during the study period: compared to 2004-2008, patients treated at 2009-2014 had relative risk (RR) reduction of 0.86 (95% CI 0.77-0.96) and three independent risk factors were identified: period of treatment at 2009 and 2014, sepsis and age> 65 years. There were 180 deaths (59.8%) during the study. Death was the leading cause of dropout (77.9% of all cases) mainly by sepsis (58.3%), followed cardiovascular disease (36.1%). The overall patient survival was 41% at 30 days. Patient survival improved along study periods: compared to 2004-2008, patients treated at 2009-2014 had a RR reduction of 0.87 (95% CI 0.79-0.98). The independent risk factors for mortality were sepsis, age >70 years, ATN-ISS > 0.65 and positive fluid balance. As conclusion, we observed an improvement in patient survival and TF along the years even after correction for several confounders and using a competing risk approach.
authors.affiliation: University São Paulo State- UNESP, Distrito de Rubiao Junior, Botucatu, Sao Paulo, Brazil.
authors.forename: Daniela
authors.initials: D
authors.lastname: Ponce
authors.affiliation: University São Paulo State- UNESP, Distrito de Rubiao Junior, Botucatu, Sao Paulo, Brazil.
authors.forename: Marina Berbel
authors.initials: MB
authors.lastname: Buffarah
authors.affiliation: University São Paulo State- UNESP, Distrito de Rubiao Junior, Botucatu, Sao Paulo, Brazil.
authors.forename: Cassiana
authors.initials: C
authors.lastname: Goes
authors.affiliation: University São Paulo State- UNESP, Distrito de Rubiao Junior, Botucatu, Sao Paulo, Brazil.
authors.forename: André
authors.initials: A
authors.lastname: Balbi
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality* / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D002423:Cause of Death / Q000639:trends; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000295:instrumentation; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome