Characteristics, complications and outcome of patients treated with automated peritoneal dialysis at the Peritoneal Dialysis Unit, University Hospital of the West Indies.

OBJECTIVE

To characterize and evaluate complications and outcomes of the patients treated with automated peritoneal dialysis (PD) at the University Hospital of the West Indies (UHWI), Jamaica.

METHOD

Retrospective data were collected from peritoneal dialysis patients' case files retrieved from the medical records department of UHWI. Demographic data (age, gender address, marital status), year of dialysis commencement, cause of end stage renal disease (ESRD), haemoglobin, serum electrolytes, serology, blood pressure readings, medications used, blood transfusion and erythropoietin use were collated. Complications such as infections (pneumonia, catheter-related infections), cardiac related disorders (congestive cardiac failure, acute coronary syndrome, pericarditis/pericardial effusion), cerebrovascular diseases, renal osteodystrophy, complications of the procedure and of end stage renal disease (ESRD), outcome and cause of death were retrieved from patients' case files for analysis.

RESULTS

There were 202 patients receiving peritoneal dialysis between September, 1999 and December 2008. Data on 190 were analysed. The case files of 12 patients were not included because of incomplete data. The ages of the studied PD patients ranged between 33 and 65 years. The mean haemoglobin was 7.4 g/dL, serum calcium of 2.1 mmol/L, serum phosphate of 1.9 mmol/L and calcium/phosphate product of 4.1mmol2/L2. The serum albumin was 32 g/L and serum total cholesterol/HDL ratio of 5.3. Most patients were from Kingston and St Andrew (56.8%), St Catherine (18.9%) and Clarendon (7.4%). Hypertension (27.9%), chronic glomerulonephritis (17.9%) and diabetes mellitus (17.4%) were the commonest causes of ESRD. There were 70.5% unmarried persons and 81.6% of patients were unemployed. HIV, Hepatitis B and Hepatitis C seropositivity were discovered in 4.1%, 1.1 and 0.5% of patients respectively. Only 20% of the patients used erythropoietin and of this 92% used it less than 50% of the prescribed frequency. Infections (43.2%) such as pneumonia, peritonitis, catheter tunnel infection, exit site infection and cardiac related complications (37.4%) such as congestive cardiac failure, acute coronary syndrome, pericarditis/pericardial effusion were the most frequently encountered complications. Forty-one per cent of patients were transferred to haemodialysis mainly on account of inadequate dialysis clearance. Sepsis (42%) such as pneumonia, urinary tract infection, peritonitis and cardiac related causes (31%) such as congestive cardiac failure and acute coronary syndrome were the two major causes of death. Of those who died of sepsis, 45.2% had pneumonia. Only 9.5% (4/42) of patients had confirmed peritonitis during their illness.

CONCLUSION

Infection and cardiovascular disease were common complications observed in this study. Therefore intensive management of risk factors (hypertension, diabetes and dyslipidaemia) and prompt recognition of infection is hereby recommended. Early recognition and appropriate management of sepsis in peritoneal dialysis patients should be initially based on standard protocol. The use of erythropoietin in peritoneal dialysis patients will enhance better management of anaemia and improve quality of life.