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      Changes in the worldwide epidemiology of peritoneal dialysis

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          Abstract

          As the global burden of chronic kidney disease continues to increase, so does the need for a cost-effective renal replacement therapy. In many countries, patient outcomes with peritoneal dialysis are comparable to or better than those with haemodialysis, and peritoneal dialysis is also more cost-effective.

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          Worldwide access to treatment for end-stage kidney disease: a systematic review.

          Thaminda Liyanage, Toshiharu Ninomiya, Vivekanand Jha … (2015)
          End-stage kidney disease is a leading cause of morbidity and mortality worldwide. Prevalence of the disease and worldwide use of renal replacement therapy (RRT) are expected to rise sharply in the next decade. We aimed to quantify estimates of this burden.
          Article 0 comments Cited 493 times – based on 0 reviews     Review now
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            Propensity-matched mortality comparison of incident hemodialysis and peritoneal dialysis patients.

            David T Gilbertson, Susan J. Snyder, Eric D Weinhandl … (2010)
            Contemporary comparisons of mortality in matched hemodialysis and peritoneal dialysis patients are lacking. We aimed to compare survival of incident hemodialysis and peritoneal dialysis patients by intention-to-treat analysis in a matched-pair cohort and in subsets defined by age, cardiovascular disease, and diabetes. We matched 6337 patient pairs from a retrospective cohort of 98,875 adults who initiated dialysis in 2003 in the United States. In the primary intention-to-treat analysis of survival from day 0, cumulative survival was higher for peritoneal dialysis patients than for hemodialysis patients (hazard ratio 0.92; 95% CI 0.86 to 1.00, P = 0.04). Cumulative survival probabilities for peritoneal dialysis versus hemodialysis were 85.8% versus 80.7% (P < 0.01), 71.1% versus 68.0% (P < 0.01), 58.1% versus 56.7% (P = 0.25), and 48.4% versus 47.3% (P = 0.50) at 12, 24, 36, and 48 months, respectively. Peritoneal dialysis was associated with improved survival compared with hemodialysis among subgroups with age <65 years, no cardiovascular disease, and no diabetes. In a sensitivity analysis of survival from 90 days after initiation, we did not detect a difference in survival between modalities overall (hazard ratio 1.05; 95% CI 0.96 to 1.16), but hemodialysis was associated with improved survival among subgroups with cardiovascular disease and diabetes. In conclusion, despite hazard ratio heterogeneity across patient subgroups and nonconstant hazard ratios during the follow-up period, the overall intention-to-treat mortality risk after dialysis initiation was 8% lower for peritoneal dialysis than for matched hemodialysis patients. These data suggest that increased use of peritoneal dialysis may benefit incident ESRD patients.
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              Peritoneal dialysis-related peritonitis: towards improving evidence, practices, and outcomes.

              David Johnson, Yeoungjee Cho (2014)
              Peritonitis is a common serious complication of peritoneal dialysis that results in considerable morbidity, mortality, and health care costs. It also significantly limits the use of this important dialysis modality. Despite its importance as a patient safety issue, peritonitis practices and outcomes vary markedly and unacceptably among different centers, regions, and countries. This article reviews peritonitis risk factors, diagnosis, treatment, and prevention, particularly focusing on potential drivers of variable practices and outcomes, controversial or unresolved areas, and promising avenues warranting further research. Potential strategies for augmenting the existing limited evidence base and reducing the gap between evidence-based best practice and actual practice also are discussed.
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                Author and article information

                Journal
                Title: Nature Reviews Nephrology
                Abbreviated Title: Nat Rev Nephrol
                Publisher: Springer Nature
                ISSN (Print): 1759-5061
                ISSN (Electronic): 1759-507X
                Publication date Created: December 28 2016
                Publication date (Print): December 28 2016
                Volume: 13
                Issue: 2
                Pages: 90-103
                Article
                DOI: 10.1038/nrneph.2016.181
                PubMed ID: 28029154
                SO-VID: a28626d4-d64e-475e-a0f4-870dda5d89e2
                Copyright © © 2016
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