Back
Patients who initiate peritoneal dialysis (PD) do as an intermittent (PDI) way before becoming outpatients because of economic reasons. Sometimes they present technical failure in any of the dialysis modalities, forcing them to migrate to hemodialysis without previous preparation.
Retrospective cohort of patients in IPD and CAPD between 2008-2022. Some factors related to technique failure were analyzed, such as catheter characteristics and episodes of peritonitis or dysfunction. Having the objective to determinate the factors associated with the survival of the peritoneal dialysis technique in the intermittent peritoneal dialysis (IPD) and continuous ambulatory peritoneal dialysis (CAPD) program of the General Hospital of Mexico.
200 patients were included in DPI, 92 (46%) migrated to CAPD; 116 (58%) were men, median age 53 (19-83) years. Catheters were pigtail in 186 (93%) and predominantly percutaneous placement in 140 (70%). We found that technique failure is not associated with urgent installation (p= 0.25), the same was observed in installation technique (p= 0.12), type of catheter (p= 0.71) nor whether they started with hemodialysis or PD (p= 0.13) in both group IPD and CAPD. The median length of stay in DPI was 130 days (1-2588). For DPI, the presence of any peritonitis event had an HR for technique failure of 4.02 (95% CI 2.5-7.7 p= 0.001) (Figure 1), and for CAPD every episode of peritonitis increases de risk of technique failure having a second peritonitis event had an HR of 3.7 (95% CI 1.2-11.1, p= 0.01), and a third episode had an HR of 4.12 (95% CI 1.13-14.9, p= 0.06) (Figure 2).
Peritonitis is a relevant factor for changing dialysis modality, so taking measures to reduce peritonitis rates is essential. Evidence that a second episode of peritonitis increases the risk of technique failure should change preventive strategies after the first episode of peritonitis in CAPD patients.