title: Impact of Pre-Dialysis Care on Clinical Outcomes in Peritoneal Dialysis Patients.
abstract: BACKGROUND
  Structured pre-dialysis care is associated with an increase in peritoneal dialysis (PD) utilization, but not with peritonitis risk, technical and patient survival. This study aimed at analyzing the impact of pre-dialysis care on these outcomes.
  
  
  METHODS
  All incident patients starting PD between 2004 and 2011 in a Brazilian prospective cohort were included in this analysis. Patients were divided into 2 groups: early pre-dialysis care (90 days of follow-up by a nephrology team); and late pre-dialysis care (absent or less than 90 days follow-up). The socio-demographic, clinical and biochemical characteristics between the 2 groups were compared. Risk factors for the time to the first peritonitis episode, technique failure and mortality based on Cox proportional hazards models.
  
  
  RESULTS
  Four thousand one hundred seven patients were included. Patients with early pre-dialysis care presented differences in gender (female - 47.0 vs. 51.1%, p = 0.01); race (white - 63.8 vs. 71.7%, p < 0.01); education (<4 years - 61.9 vs. 71.0%, p < 0.01), respectively, compared to late care. Patients with early pre-dialysis care presented a higher prevalence of comorbidities, lower levels of creatinine, phosphorus, and glucose with a significantly better control of hemoglobin and potassium serum levels. There was no impact of pre-dialysis care on peritonitis rates (hazard ratio (HR) 0.88; 95% CI 0.77-1.01) and technique survival (HR 1.12; 95% CI 0.92-1.36). Patient survival (HR 1.20; 95% CI 1.03-1.41) was better in the early pre-dialysis care group.
  
  
  CONCLUSIONS
  Earlier pre-dialysis care was associated with improved patient survival, but did not influence time to the first peritonitis nor technique survival in this national PD cohort.
authors.affiliation: School of Medicine, Pontifx00ED;cia Universidade Catx00F3;lica do Paranx00E1; (PUCPR), Curitiba, Brazil.
authors.forename: Dandara N
authors.initials: DN
authors.lastname: Spigolon
authors.forename: Thyago P
authors.initials: TP
authors.lastname: de Moraes
authors.forename: Ana E
authors.initials: AE
authors.lastname: Figueiredo
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Modesto
authors.forename: Pasqual
authors.initials: P
authors.lastname: Barretti
authors.forename: Marcus Gomes
authors.initials: MG
authors.lastname: Bastos
authors.forename: Daniela V
authors.initials: DV
authors.lastname: Barreto
authors.forename: Roberto
authors.initials: R
authors.lastname: Pecoits-Filho
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D001938:Brazil / Q000453:epidemiology; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000379:methods*; D058729:Peripheral Arterial Disease / Q000453:epidemiology; D010530:Peritoneal Dialysis / Q000009:adverse effects; D010538:Peritonitis / Q000453:epidemiology* / Q000209:etiology; D011188:Potassium / Q000097:blood; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors
chemical_list: D006454:Hemoglobins; D011188:Potassium