Treatment practices and outcomes in incident peritoneal dialysis patients: The Swedish Renal Registry 2006-2015

Hong Xu, Bengt Lindholm, Ulrika Hahn Lundström, Olof Heimbürger, Maria Stendahl, Helena Rydell, Mårten Segelmark, Juan Jesus Carrero, Marie Evans

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Therapeutic developments have contributed to markedly improved clinical outcomes in peritoneal dialysis (PD) during the 1990s and 2000s. We investigated whether recent advances in PD treatment are implemented in routine Swedish care and whether their implementation parallels improved patient outcomes. Methods: We conducted an observational study of 3122 patients initiating PD in Sweden from 2006 to 2015. We evaluated trends of treatment practices (medications, PD-related procedures) and outcomes [patient survival, major adverse cardiovascular events (MACEs), peritonitis, transfer to haemodialysis (HD) and kidney transplantation] and analysed associations of changes of treatment practices with changes in outcomes. Results: Over the 10-year period, demographics (mean age 63 years, 33% women) and comorbidities remained essentially stable. There were changes in clinical characteristics (body mass index and diastolic blood pressure increased), prescribed drugs (calcium channel blockers, non-calcium phosphate binders and cinacalcet increased and the use of renin-angiotensin system inhibitors, erythropoietin and iron decreased) and dialysis treatment (increased use of automated PD, icodextrin and assisted PD). The standardized 1- and 2-year mortality and MACE risk did not change over the period. Compared with the general population, the risk of 1-year mortality was 4.1 times higher in 2006-2007 and remained stable throughout follow-up. However, the standardized 1- and 2-year peritonitis rate decreased and the incidence of kidney transplantation increased while transfers to HD did not change. Conclusions: Over the last decade, treatment advances in PD patients were accompanied by a substantial decline in peritonitis frequency and an increased rate of kidney transplantations, while 1- and 2-year survival and MACE risk did not change.

Original languageEnglish
Pages (from-to)2539-2547
Number of pages9
JournalClinical Kidney Journal
Volume14
Issue number12
DOIs
Publication statusPublished - 2021 Dec 1

Subject classification (UKÄ)

  • Urology and Nephrology

Free keywords

  • kidney transplantation
  • major cardiovascular events
  • mortality
  • peritoneal dialysis
  • peritonitis
  • technique failure

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