Survival Rate of Renal Replacement Therapy Patients in Charoenkrung Pracharak Hospital
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Published:
Feb 1, 2018
Keywords:
hemodialysis continuous ambulatory peritoneal dialysis survival analysis dialysis modality
Main Article Content
Abstract
Objective: This study aimed to analyze survival data and the factors associated with treatment outcomes in end-stage renal disease (ESRD) patients.
Methods: This was a retrospective analysis of survival data in a single-center cohort of 337 ESRD patients between 2009 and 2015. The database of medical records such as baseline demographics, comorbidities and mortality data were analyzed by cox-regression analysis and Kaplan-Meier analysis.
Results: One hundred seventy-four (51.6%) patients were male and 163 (48.4%) patients were female. 181(53.7%) patients were on continuous ambulatory peritoneal dialysis (CAPD), 156 (36.3%) patients were on hemodialysis (HD), 153 (45.4%) patients started renal replacement therapy (RRT) at eGFRs between 3.01-5.99 cc/min/1.73m2, 130 (38.6%) patients started RRT at eGFR more than 6 cc/min/1.73m2, and 54 (16%) patients started RRT at eGFR below 3 cc/min/1.73m2. As for laboratory results, hematocrit level was 29 ± 5.4%, serum calcium was 8.7 ± 1.3 mg/dL, serum phosphate was 4.5 ± 2.8 mg/dL, and intact parathyroid was 464.4 ± 556.8 pg/mL. The average duration of treatment in HD patients (773.8 ± 544.8 days) was statistically significantly higher than the average duration of treatment in CAPD patients (567.5 ± 556.8 days); the risk of death was higher in patients initiating dialysis with CAPD than those initiating dialysis with HD (hazard ratio (HR) = 7.86; 95% confidence interval (CI) 2.56–21.13; p<0.001). Patients over 60 years old had a higher risk of death compared to those younger than 60 (HR = 3.32; 95% CI 1.23-8.91; p<0.05).
Conclusion: ESRD patients, initiating dialysis with HD had better survival outcomes than those initiating dialysis with CAPD. These findings were potentially confounded by many factors. Randomized controlled trials should be conducted as well as matching in subjects should be carried out to answer this question.
Article Details
How to Cite
Chongthanakorn, K. (2018). Survival Rate of Renal Replacement Therapy Patients in Charoenkrung Pracharak Hospital. Vajira Medical Journal : Journal of Urban Medicine, 62(1), 9–20. Retrieved from https://he02.tci-thaijo.org/index.php/VMED/article/view/195766
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Original Articles
References
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26. Levey AS, Stevens LA, Schmid CH, Zhang Y, Castro III AF, Feldman HI, et al. A new equationto estimate glomerular filtration rate. Ann Intern Med. 2009; 150: 604-12.
27. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001; 285:2486–97.
28. McDonald SP, Marshall MR, Johnson DW, Polkinghorne KR. Relationship between dialysis modality and mortality. J Am Soc Nephrol. 2009;20(1):155-63.
29. Heaf JG, Løkkegaard H, Madsen M. Initial survival advantage of peritoneal dialysis relative to haemodialysis. Nephrol Dial Transplant. 2002;17(1):112-7.
30. Hemodialysis Adequacy 2015 Work group. KDOQI clinical practice guideline for hemodialysis adequacy: 2015 update. AM J Kidney Dis 2015;66(5): 884-930
31. Krairittichai U, Supaporn T, Aimpun P. Thailand registry patient survival report on chronic hemodialysis. J Am Soc Nephrol. 2005; 16:292A.
32. Lo WK, Barkman JM, Burkart J, Krediet RT, Pollock C, Kawanishi H, et al. ISPD guilelines0 Recommendation: Guideline on targets for solute and fluid removal in adult patients on chronic peritoneal dialysis. Perit Dial Int. 2006;26:520-2
33. Snyder JJ, Forley RN, Gilberton GT, Vonesh EF, Collins AJ. Hemoglobin levels and erythropoietin doses in hemodialysis and peritoneal dialysis patients in the United States. J Am Soc Nephrol.2004; 15:174-79
34. Wang WN, Zhang WL, Sun T, Ma FZ, Su S, Zu ZG. Effect of peritoneal dialysis versus hemodialysis on renal anemia in renal in end-stage disease patients: a meta-analysis. Renal Fail. 2015;39(1):59-66
35. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int. 2009; 76(Suppl 113): S1-S130.
36. Andress DL. Adynamic bone in patients with chronic kidney disease. Kidney Int. 2008; 73:1345-54.
37. Liu CT, Lin YC, Lin YC, Kao CC, Chen HH, Hsu CC, et al. Roles of Serum Calcium, Phosphorus, PTH and ALP on Mortality in Peritoneal Dialysis Patients: A Nationwide, Population-based Longitudinal Study Using TWRDS 2005–2012. Nature. 2017; 33:1-9.
38. Tentori F, Blayney MJ, Albert JM, Gillespie BW, Kerr PG, Bommer J et al. Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2008; 52:510-30.
39. Fernández-Martín JL, Martínez-Camblor P, Dionisi MP, Floege J, Ketteler M, London G, et al. Improvement of mineral and bone metabolism markers is associated with better survival in haemodialysis patients: the COSMOS study. Nephrol Dial Transplant. 2015; 30: 1542–51.
2. Ingsathit A, Thakkinstian A, Chaiprasert A, Sangthawan P, Gojaseni P, Kiattisunthorn K; theThai-SEEK Group. Prevalence and risk factors of chronic kidney disease in the Thai adultpopulation: Thai SEEK study. Nephrol Dial Transplant. 2010; 25: 1567-75.
3. TRT registry sub-committee, The nephrology society of Thailand. Thailand renal replacement therapy registry: Annual report 2014.
4. Fleming GM. Renal replacement therapy review past, present and future. Organogenesis 2011;7(1): 2-12.
5. United States Renal Data System 2009. Chapter 6: Morbidity and Mortality. [internet]. [Cited 2007 July 20], Available from https://www.usrds.org/adr.htm
6. Collins AJ, Hao W, Xia H, Ebben JP, Everson SE, Constantini EG, Ma JZ. Mortality Risks of Peritoneal Dialysis and Hemodialysis. Am J Kidney Dis. 1999;36:1065-74.
7. Jaar BG, Coresh J, Plantinga LC, Fink NE, Klag MJ, Levey AS, et al. Comparing the Risk for Death with Peritoneal Dialysis and Hemodialysis in a National Cohort of Patients with Chronic Kidney Disease. Ann Intern Med. 2005; 143: 174-83.
8. Chung SH, Han DC, Noh H, Jeon JS, Kwon SH, Lindholm B, et al. Risk factors for mortality in diabetic peritoneal dialysis patients. Nephrol Dial Transplant, 2010;25(11): 3742-8.
9. Murthy B, Molony D, Stack A. Survival Advantage of Hispanic Patients Initiating Dialysis in the United States Is Modified by Race. J Am Soc Nephrol. 2005;16: 782-90.
10. McDonald SP, Marshall MR, Johnson DW, Polkinghorne KR. Relationship between dialysis modality and mortality. J Am Soc Nephrol. 2009; 20(1):155–63.
11. Jaar BG, Coresh J, Plantinga LC, Fink NE, Klag MJ, Levey AS, et al. Comparing the risk for death with peritoneal dialysis and hemodialysis in a national cohort of patients with chronic kidney disease. Ann Intern Med. 2005; 143(3):174–83.
12. Termorshuizen F, Korevaar JC, Dekker FW, Van Manen JG, Boeschoten EW, Krediet RT. Hemodialysis and peritoneal dialysis: comparison of adjusted mortality rates according to the duration of dialysis: analysis of The Netherlands Cooperative Study on the Adequacy of Dialysis 2. J Am Soc Nephrol. 2003; 14(11):2851–60.
13. Kim H, Kim KH, Park K, Kang SW, Yoo TH, Ahn SV, et al. A population-based approach indicates an overall higher patient mortality with peritoneal dialysis compared to hemodialysis in Korea. Kidney Int. 2014; 86(5):991–1000.
14. Yang F, Khin LW, Lau T, Chua HR, Vathsala A, Lee E, et al. Hemodialysis versus Peritoneal Dialysis: A Comparison of Survival Outcomes in South-East Asian Patients with End-Stage Renal Disease. PLoS One. 2015;10(10):e0140195
15. Chang YK, Hsu CC, Hwang SJ, Chen PC, Huang CC, Li TC, et al. A comparative assessment of survival between propensity score-matched patients with peritoneal dialysis and hemodialysis in Taiwan. Medicine. 2012; 91(3):144–51.
16. Huang CC, Cheng KF, Wu HDI. Survival analysis: Comparing peritoneal dialysis and hemodialysis in Taiwan. Periton Dial Int. 2008; 28:S15–S20.
17. Maiorca R, Vonesh EF, Cavalli P, De Vecchi A, Giangrande A, La Greca G, et al. A multicenter, selection-adjusted comparison of patient and technique survivals on CAPD and hemodialysis. Perit Dial Int. 1991;11(2):118-27.
18. Locatelli F, Marcelli D, Conte F, D'Amico M, Del Vecchio L, Limido A, et al. Survival and development of cardiovascular disease by modality of treatment in patients with end-stage renal disease. J Am Soc Nephrol. 2001;12(11):2411-7.
19. Yeates K, Zhu N, Vonesh E, Trpeski L, Blake P, Fenton S. Hemodialysis and peritoneal dialysis are associated with similar outcomes for end-stage renal disease treatment in Canada. Nephrol Dial Transplant. 2012;27(9): 3568-75.
20. Heaf JG, Lokkegaard H, Madsen M. Initial survival advantage of peritoneal dialysis relative to haemodialysis. Nephrol Dial Transplant. 2002; 17(1):112–7.
21. Miskulin DC, Meyer KB, Athienites NV, Martin AA, Terrin N. Comorbidity and other factors associated with modality selection in incident dialysis patients: the CHOICE Study. Choices for Healthy Outcomes in Caring for End-Stage Renal Disease. Am J Kidney Dis. 2002;39(2): 324-36
22. Murphy SW, Foley RN, Barrett BJ, Kent GM, Morgan J, Barré P, et al. Comparative mortality of hemodialysis and peritoneal dialysis in Canada. Kidney Int. 2000;57(4):1720-6.
23. Just PM, Riella MC, Tschosik EA, NoeL L, Bhattacharyya SK, de Charro F. Economic evaluations of dialysis treatment modalities. Health Policy. 2008; 86:163-80.
24. Liu FX, Quock TP, John B, Noe L, Inglese G. Economic evaluations of peritoneal dialysis and hemodialysis: 2004-2012. F1000 Res. 2013;2:273.
25. Klarenbach S, Manns B. Economic evaluation of dialysis therapies. Semin Nephrol. 2009;29:524-32.
26. Levey AS, Stevens LA, Schmid CH, Zhang Y, Castro III AF, Feldman HI, et al. A new equationto estimate glomerular filtration rate. Ann Intern Med. 2009; 150: 604-12.
27. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001; 285:2486–97.
28. McDonald SP, Marshall MR, Johnson DW, Polkinghorne KR. Relationship between dialysis modality and mortality. J Am Soc Nephrol. 2009;20(1):155-63.
29. Heaf JG, Løkkegaard H, Madsen M. Initial survival advantage of peritoneal dialysis relative to haemodialysis. Nephrol Dial Transplant. 2002;17(1):112-7.
30. Hemodialysis Adequacy 2015 Work group. KDOQI clinical practice guideline for hemodialysis adequacy: 2015 update. AM J Kidney Dis 2015;66(5): 884-930
31. Krairittichai U, Supaporn T, Aimpun P. Thailand registry patient survival report on chronic hemodialysis. J Am Soc Nephrol. 2005; 16:292A.
32. Lo WK, Barkman JM, Burkart J, Krediet RT, Pollock C, Kawanishi H, et al. ISPD guilelines0 Recommendation: Guideline on targets for solute and fluid removal in adult patients on chronic peritoneal dialysis. Perit Dial Int. 2006;26:520-2
33. Snyder JJ, Forley RN, Gilberton GT, Vonesh EF, Collins AJ. Hemoglobin levels and erythropoietin doses in hemodialysis and peritoneal dialysis patients in the United States. J Am Soc Nephrol.2004; 15:174-79
34. Wang WN, Zhang WL, Sun T, Ma FZ, Su S, Zu ZG. Effect of peritoneal dialysis versus hemodialysis on renal anemia in renal in end-stage disease patients: a meta-analysis. Renal Fail. 2015;39(1):59-66
35. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int. 2009; 76(Suppl 113): S1-S130.
36. Andress DL. Adynamic bone in patients with chronic kidney disease. Kidney Int. 2008; 73:1345-54.
37. Liu CT, Lin YC, Lin YC, Kao CC, Chen HH, Hsu CC, et al. Roles of Serum Calcium, Phosphorus, PTH and ALP on Mortality in Peritoneal Dialysis Patients: A Nationwide, Population-based Longitudinal Study Using TWRDS 2005–2012. Nature. 2017; 33:1-9.
38. Tentori F, Blayney MJ, Albert JM, Gillespie BW, Kerr PG, Bommer J et al. Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2008; 52:510-30.
39. Fernández-Martín JL, Martínez-Camblor P, Dionisi MP, Floege J, Ketteler M, London G, et al. Improvement of mineral and bone metabolism markers is associated with better survival in haemodialysis patients: the COSMOS study. Nephrol Dial Transplant. 2015; 30: 1542–51.