Improving outcome of CAPD: Twenty-five years' experience in a single Korean center

Seung Hyeok Han, Sang Choel Lee, Song Vogue Ahn, Jung Eun Lee, Hoon Young Choi, Beom Seok Kim, Shin Wook Kang, Kyu Hun Choi, Dae Suk Han, Ho Yung Lee

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Abstract

◆ Background: Continuous ambulatory peritoneal dialysis (CAPD) is an established treatment for end-stage renal disease (ESRD). We investigated the outcome of CAPD over a period of 25 years at our institution. ◆ Methods: CAPD has been performed in 2301 patients in 25 years. After excluding patients with less than 3 months of follow-up and missing data, we evaluated 1656 patients who started peritoneal dialysis between November 1981 and December 2005. Data for sex, age, primary disease, comorbidities, follow-up duration, cause of death, and cause of technique failure were collected. We also examined data for urea kinetic modeling (UKM), beginning in 1990, and peritonitis episodes, including causative organisms, starting in 1992. ◆ Results: Compared to incident patients from 1981-1992, mean age and incidence of ESRD caused by diabetic nephropathy increased in patients from 1993 to 2005. Technique survival after 5 and 10 years was 71.9% and 48.1% respectively. Technique survival was significantly higher in patients who started CAPD after 1992 than in those who started before 1992. Peritonitis was the main reason for technique failure. Overall peritonitis rate was 0.38 episodes per patient-year, with a significant downward trend to 0.29 per patient-year over 10 years, corresponding to a decrease in gram-positive peritonitis. Patient survival after 5 and 10 years was 69.8% and 51.8% respectively. Patient survival improved significantly during 1992-2005 compared to 1981-1992 after adjustment for age, gender, diabetes, and cardiovascular comorbidities [hazard ratio (HR) 0.68, p < 0.01]. Subgroup analysis based on UKM revealed that dialysis adequacy did not affect patient survival. However, diabetes (HR 2.78, p < 0.001), older age (per 1 year: HR 1.06; p < 0.001), serum albumin level (per 1 g/dL: increase, HR 0.52; p < 0.05), and cardiovascular comorbidities (HR 2.32, p < 0.01) were identified as significant risk factors. ◆ Conclusion: Technique survival has improved due partly to a decrease in peritonitis, which was attributed to a decrease in gram-positive peritonitis. Patient survival has also improved considering increases in aged patients and ESRD caused by diabetes. The mortality rate of CAPD is still high in older, diabetic, malnourished, and cardiovascular diseased patients. A more careful management of higher risk groups will be needed to improve the outcome of CAPD patients in the future.

Original languageEnglish
Pages (from-to)432-440
Number of pages9
JournalPeritoneal Dialysis International
Volume27
Issue number4
Publication statusPublished - 2007 Jul 1

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Continuous Ambulatory Peritoneal Dialysis
Peritonitis
Survival
Chronic Kidney Failure
Comorbidity
Urea
Risk Management
Diabetic Nephropathies
Peritoneal Dialysis
Serum Albumin

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Han, S. H., Lee, S. C., Ahn, S. V., Lee, J. E., Choi, H. Y., Kim, B. S., ... Lee, H. Y. (2007). Improving outcome of CAPD: Twenty-five years' experience in a single Korean center. Peritoneal Dialysis International, 27(4), 432-440.
Han, Seung Hyeok ; Lee, Sang Choel ; Ahn, Song Vogue ; Lee, Jung Eun ; Choi, Hoon Young ; Kim, Beom Seok ; Kang, Shin Wook ; Choi, Kyu Hun ; Han, Dae Suk ; Lee, Ho Yung. / Improving outcome of CAPD : Twenty-five years' experience in a single Korean center. In: Peritoneal Dialysis International. 2007 ; Vol. 27, No. 4. pp. 432-440.
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abstract = "◆ Background: Continuous ambulatory peritoneal dialysis (CAPD) is an established treatment for end-stage renal disease (ESRD). We investigated the outcome of CAPD over a period of 25 years at our institution. ◆ Methods: CAPD has been performed in 2301 patients in 25 years. After excluding patients with less than 3 months of follow-up and missing data, we evaluated 1656 patients who started peritoneal dialysis between November 1981 and December 2005. Data for sex, age, primary disease, comorbidities, follow-up duration, cause of death, and cause of technique failure were collected. We also examined data for urea kinetic modeling (UKM), beginning in 1990, and peritonitis episodes, including causative organisms, starting in 1992. ◆ Results: Compared to incident patients from 1981-1992, mean age and incidence of ESRD caused by diabetic nephropathy increased in patients from 1993 to 2005. Technique survival after 5 and 10 years was 71.9{\%} and 48.1{\%} respectively. Technique survival was significantly higher in patients who started CAPD after 1992 than in those who started before 1992. Peritonitis was the main reason for technique failure. Overall peritonitis rate was 0.38 episodes per patient-year, with a significant downward trend to 0.29 per patient-year over 10 years, corresponding to a decrease in gram-positive peritonitis. Patient survival after 5 and 10 years was 69.8{\%} and 51.8{\%} respectively. Patient survival improved significantly during 1992-2005 compared to 1981-1992 after adjustment for age, gender, diabetes, and cardiovascular comorbidities [hazard ratio (HR) 0.68, p < 0.01]. Subgroup analysis based on UKM revealed that dialysis adequacy did not affect patient survival. However, diabetes (HR 2.78, p < 0.001), older age (per 1 year: HR 1.06; p < 0.001), serum albumin level (per 1 g/dL: increase, HR 0.52; p < 0.05), and cardiovascular comorbidities (HR 2.32, p < 0.01) were identified as significant risk factors. ◆ Conclusion: Technique survival has improved due partly to a decrease in peritonitis, which was attributed to a decrease in gram-positive peritonitis. Patient survival has also improved considering increases in aged patients and ESRD caused by diabetes. The mortality rate of CAPD is still high in older, diabetic, malnourished, and cardiovascular diseased patients. A more careful management of higher risk groups will be needed to improve the outcome of CAPD patients in the future.",
author = "Han, {Seung Hyeok} and Lee, {Sang Choel} and Ahn, {Song Vogue} and Lee, {Jung Eun} and Choi, {Hoon Young} and Kim, {Beom Seok} and Kang, {Shin Wook} and Choi, {Kyu Hun} and Han, {Dae Suk} and Lee, {Ho Yung}",
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Han, SH, Lee, SC, Ahn, SV, Lee, JE, Choi, HY, Kim, BS, Kang, SW, Choi, KH, Han, DS & Lee, HY 2007, 'Improving outcome of CAPD: Twenty-five years' experience in a single Korean center', Peritoneal Dialysis International, vol. 27, no. 4, pp. 432-440.

Improving outcome of CAPD : Twenty-five years' experience in a single Korean center. / Han, Seung Hyeok; Lee, Sang Choel; Ahn, Song Vogue; Lee, Jung Eun; Choi, Hoon Young; Kim, Beom Seok; Kang, Shin Wook; Choi, Kyu Hun; Han, Dae Suk; Lee, Ho Yung.

In: Peritoneal Dialysis International, Vol. 27, No. 4, 01.07.2007, p. 432-440.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Improving outcome of CAPD

T2 - Twenty-five years' experience in a single Korean center

AU - Han, Seung Hyeok

AU - Lee, Sang Choel

AU - Ahn, Song Vogue

AU - Lee, Jung Eun

AU - Choi, Hoon Young

AU - Kim, Beom Seok

AU - Kang, Shin Wook

AU - Choi, Kyu Hun

AU - Han, Dae Suk

AU - Lee, Ho Yung

PY - 2007/7/1

Y1 - 2007/7/1

N2 - ◆ Background: Continuous ambulatory peritoneal dialysis (CAPD) is an established treatment for end-stage renal disease (ESRD). We investigated the outcome of CAPD over a period of 25 years at our institution. ◆ Methods: CAPD has been performed in 2301 patients in 25 years. After excluding patients with less than 3 months of follow-up and missing data, we evaluated 1656 patients who started peritoneal dialysis between November 1981 and December 2005. Data for sex, age, primary disease, comorbidities, follow-up duration, cause of death, and cause of technique failure were collected. We also examined data for urea kinetic modeling (UKM), beginning in 1990, and peritonitis episodes, including causative organisms, starting in 1992. ◆ Results: Compared to incident patients from 1981-1992, mean age and incidence of ESRD caused by diabetic nephropathy increased in patients from 1993 to 2005. Technique survival after 5 and 10 years was 71.9% and 48.1% respectively. Technique survival was significantly higher in patients who started CAPD after 1992 than in those who started before 1992. Peritonitis was the main reason for technique failure. Overall peritonitis rate was 0.38 episodes per patient-year, with a significant downward trend to 0.29 per patient-year over 10 years, corresponding to a decrease in gram-positive peritonitis. Patient survival after 5 and 10 years was 69.8% and 51.8% respectively. Patient survival improved significantly during 1992-2005 compared to 1981-1992 after adjustment for age, gender, diabetes, and cardiovascular comorbidities [hazard ratio (HR) 0.68, p < 0.01]. Subgroup analysis based on UKM revealed that dialysis adequacy did not affect patient survival. However, diabetes (HR 2.78, p < 0.001), older age (per 1 year: HR 1.06; p < 0.001), serum albumin level (per 1 g/dL: increase, HR 0.52; p < 0.05), and cardiovascular comorbidities (HR 2.32, p < 0.01) were identified as significant risk factors. ◆ Conclusion: Technique survival has improved due partly to a decrease in peritonitis, which was attributed to a decrease in gram-positive peritonitis. Patient survival has also improved considering increases in aged patients and ESRD caused by diabetes. The mortality rate of CAPD is still high in older, diabetic, malnourished, and cardiovascular diseased patients. A more careful management of higher risk groups will be needed to improve the outcome of CAPD patients in the future.

AB - ◆ Background: Continuous ambulatory peritoneal dialysis (CAPD) is an established treatment for end-stage renal disease (ESRD). We investigated the outcome of CAPD over a period of 25 years at our institution. ◆ Methods: CAPD has been performed in 2301 patients in 25 years. After excluding patients with less than 3 months of follow-up and missing data, we evaluated 1656 patients who started peritoneal dialysis between November 1981 and December 2005. Data for sex, age, primary disease, comorbidities, follow-up duration, cause of death, and cause of technique failure were collected. We also examined data for urea kinetic modeling (UKM), beginning in 1990, and peritonitis episodes, including causative organisms, starting in 1992. ◆ Results: Compared to incident patients from 1981-1992, mean age and incidence of ESRD caused by diabetic nephropathy increased in patients from 1993 to 2005. Technique survival after 5 and 10 years was 71.9% and 48.1% respectively. Technique survival was significantly higher in patients who started CAPD after 1992 than in those who started before 1992. Peritonitis was the main reason for technique failure. Overall peritonitis rate was 0.38 episodes per patient-year, with a significant downward trend to 0.29 per patient-year over 10 years, corresponding to a decrease in gram-positive peritonitis. Patient survival after 5 and 10 years was 69.8% and 51.8% respectively. Patient survival improved significantly during 1992-2005 compared to 1981-1992 after adjustment for age, gender, diabetes, and cardiovascular comorbidities [hazard ratio (HR) 0.68, p < 0.01]. Subgroup analysis based on UKM revealed that dialysis adequacy did not affect patient survival. However, diabetes (HR 2.78, p < 0.001), older age (per 1 year: HR 1.06; p < 0.001), serum albumin level (per 1 g/dL: increase, HR 0.52; p < 0.05), and cardiovascular comorbidities (HR 2.32, p < 0.01) were identified as significant risk factors. ◆ Conclusion: Technique survival has improved due partly to a decrease in peritonitis, which was attributed to a decrease in gram-positive peritonitis. Patient survival has also improved considering increases in aged patients and ESRD caused by diabetes. The mortality rate of CAPD is still high in older, diabetic, malnourished, and cardiovascular diseased patients. A more careful management of higher risk groups will be needed to improve the outcome of CAPD patients in the future.

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