Kang Minjung, Kim Yae Lim, Kang Eunjeong, Ryu Hyunjin, Kim Yong Chul, Kim Dong Ki, Lee Hajeong, Han Seung Seok, Joo Kwon-Wook, Kim Yon Su, Ahn Curie, Oh Kook-Hwan
Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Kidney Res Clin Pract. 2021 Sep;40(3):472-483. doi: 10.23876/j.krcp.21.020. Epub 2021 Jul 1.
Peritoneal dialysis (PD) is improving as a renal replacement therapy for end-stage renal disease (ESRD) patients. We analyzed the main outcomes of PD over the last three decades at a single large-scale PD center with an established high-quality care system.
As a retrospective cohort study, we included participants (n = 1,203) who began PD between 1990 and 2019. Major PD-related outcomes were compared among the three 10-year cohorts.
The 1,203 participants were 58.3% male with a mean age of 47.9 ± 13.8 years. The median PD treatment duration was 45 months (interquartile range, 19-77 months); 362 patients (30.1%) transferred to hemodialysis, 289 (24.0%) received kidney transplants, and 224 (18.6%) died. Overall, the 5- and 8-year adjust patient survival rates were 64% and 49%, respectively. Common causes of death included infection (n = 55), cardiac (n = 38), and cerebrovascular (n = 17) events. The 5- and 8-year technique survival rates were 77% and 62%, respectively, with common causes of technique failure being infection (42.3%) and solute/water clearance problems (22.7%). The 5-year patient survival significantly improved over time (64% for the 1990-1999 cohort vs. 93% for the 2010-2019 cohort). The peritonitis rate also substantially decreased over time, from 0.278 episodes/patient-year (2000-2004) to 0.162 episodes/patient-year (2015-2019).
PD is an effective treatment option for ESRD patients. There was a substantial improvement in the patient survival and peritonitis rates over time. Establishing adequate infrastructure and an effective system for high-quality PD therapy may be warranted to improve PD outcomes.
腹膜透析（PD）作为终末期肾病（ESRD）患者的肾脏替代治疗方法正在不断改进。我们分析了在一个拥有成熟高质量护理系统的大型单一PD中心过去三十年中PD的主要结局。
作为一项回顾性队列研究，我们纳入了1990年至2019年间开始进行PD的参与者（n = 1,203）。在三个10年队列中比较了主要的PD相关结局。
1,203名参与者中男性占58.3%，平均年龄为47.9±13.8岁。PD治疗的中位持续时间为45个月（四分位间距，19 - 77个月）；362例患者（30.1%）转为血液透析，289例（24.0%）接受了肾移植，224例（18.6%）死亡。总体而言，调整后的5年和8年患者生存率分别为64%和49%。常见死亡原因包括感染（n = 55）、心脏（n = 38）和脑血管（n = 17）事件。5年和8年的技术生存率分别为77%和62%，技术失败的常见原因是感染（42.3%）和溶质/水清除问题（22.7%）。5年患者生存率随时间显著提高（1990 - 1999年队列中为64%，而2010 - 2019年队列为93%）。腹膜炎发生率也随时间大幅下降，从0.278次/患者年（2000 - 2004年）降至0.162次/患者年（2015 - 2019年）。
PD是ESRD患者的一种有效治疗选择。随着时间的推移，患者生存率和腹膜炎发生率有了显著改善。建立适当基础设施和有效的高质量PD治疗系统可能有助于改善PD结局。
