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Peritoneal dialysis (PD) offers a greater rate of patient comfort and better survival at lower costs than other forms of kidney replacement therapy (KRT). However, long-term therapy appears to be exceedingly challenging because of peritonitis, mechanical issues, and possibly dialysis failure. It is possible to take the proper steps for treatment and prevention if the precise causes of PD discontinuation are known. In this study, we looked into the causes of PD treatment termination in our facility.
A retrospective study was done on the data of PD patients who were monitored in our facility between 2012 and 2023. Data included the etiology, comorbidities of the patients, catheter placement technique, duration of PD, reasons for stopping therapy, and types of mechanical problems.
Of the 132 PD patients treated between 2012 and 2023, 83 stopped their treatment. Male patients made up 50.6% of the population, with a mean age of 54.4 years and a PD duration of 33.5 months. The causes of end-stage kidney disease were identified as diabetic nephropathy in 39.8%, nephrosclerosis in 16.9%, autosomal dominant polycystic kidney disease in 12%, and chronic glomerulonephritis in 13.3%. Only one patient had cancer, and 59% of the patients had diabetes mellitus. A nephrologist placed 12% of the PD catheters, whereas the surgeon laparoscopically implanted 37.3% of them. The primary causes of stopping PD therapy between 2020 and 2022 were death (10 out of 27 patients), dialysis failure (20 patients), peritonitis (19 patients), and kidney transplant (7 patients). In 10 of the cases, mechanical difficulties occurred; one had hydrothorax, two had hernias, and seven had leaks. Patients who had a catheter placed by a nephrologist experienced no difficulties, underwent PD treatment for a longer duration of time (35.6+-33.3 months), and the most frequent cause of treatment termination was dialysis failure. Catheters implanted through open surgery were more likely to cause mechanical issues and peritonitis.
PD is a reliable alternative to KRT. Only a few of our patients experienced mechanical issues. The widespread death rate was attributed to the Covid-19 epidemic. The third reason for stopping treatment was peritonitis. In order to diagnose and treat peritonitis, it is evident that closer monitoring and quicker action are needed. Most likely because the surgical technique was favored in more problematic patients, there were fewer problems in those who had a catheter put by the nephrologist.