Abstract:

Objective: To evaluate pre-dialysis assessment and prognosis of patients with peritoneal dialysis (PD) and to identify risk factors that affect survival rate of PD patients so as to further improve prognosis. Methodology: One hundred and eighty one patients, who started PD therapy from January 2006 to December 2007, were enrolled this study. These patients were divided into two groups: elderly group (age >= 65 yrs, n=96) and non-elderly group (age 18-65 yrs, n=85). The baseline characteristics, pre-dialysis complications, dialysis adequacy, incidence of peritonitis, survival rate, and cause of death between the two groups were compared. Cox hazard proportional regression model was used to identify risk factor of death during the follow up period. Results: There was no statistical significance of most of the clinical features, including weight, blood pressure, serum albumin level, serum hemoglobin level, residual renal function, calcium phosphorus product, serum parathyroid hormone (PTH) level, 25-hydroxy vitamin D₃ between the two groups. Elderly group had a higher prevalence of pre-dialysis complications than that in the non-elderly group [hypertension (88.5% vs 68.2% P=0.001), cardiovascular disease (69.8% vs 30.6% P<0.001), peripheral vascular diseases (38.5% vs 18.8% P=0.003)]. Although dialysis adequacy [KT/V 1.98±0.47 vs 2.06±0.41; Ccr (57.9±25.3) vs (61.4±24.4) L/week/1.73m² P>0.05] and peritonitis rate (forty times in 24 elderly patients versus 51 times in 25 non-elderly patients, P>0.05) were similar between the elderly and non-elderly groups, the mortality in the former was higher than the latter. We have observed until May 2009 that there were 51 deaths in the elderly group and 17 in the non-elderly group. The elderly group had statistically significant lower 12-month (66.69% vs 82.31%) and 36-month (39.37% vs75.90%) survival rates than the non-elderly group (P <0.001). Infection (26/68) and cardiovascular events (18/68) were the main causes of death for all PD patients. As for the elderly PD patients, stroke (5 / 51) and upper gastrointestinal bleeding (4 / 51) could not be neglected. COX hazard proportional regression model showed vascular diseases (cerebro-cardiovascular and peripheral vascular diseases) was an independent risk factor of mortalities. (RR=4.076, 95%CI: 1.111-14.905, P=0.034) Conclusion: In the context of similar baseline characteristics, dialysis adequacy and incidence of peritonitis between the elderly and non-elderly PD patients. The elderly group had significantly lower short-term and long-term survival rates than the non-elderly group, mainly due to higher incidence of pre-dialysis cerebro-cardiovascular complications. Therefore we should reinforce prevention, evaluation and treatment of complications of all PD patients.