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PD IN THE DEVELOPING WORLD |
Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
Correspondence to: N. Prasad, Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014 India. narayan{at}sgpgi.ac.in
Background: Continuous ambulatory peritoneal dialysis
(CAPD) has been an established modality of renal replacement therapy in India
for a decade, but there is a paucity of published data on the outcome of CAPD
patients in India. We analyzed our data to determine the overall predictors of
survival and compared patient survival between diabetic and nondiabetic
end-stage renal disease patients on CAPD. Methods: Of 373 patients, 197 were diabetic (165 males,
32 females) and 176 nondiabetic (104 males, 72 females). Patients were
followed for 22 ± 14 patient-months. Patients were prospectively
followed until the study end point or death. Results: Overall median survival was 48 patient-months.
Median survival of diabetics (34.5 patient-months) was significantly inferior
to nondiabetic patients (59 patient-months) p = 0.001. Overall
patient survival at 1, 2, 3, 4, and 5 years was 90%, 72%, 60%, 49%, and 39%,
respectively. Patient survival of diabetics versus nondiabetics at 1, 2, 3, 4,
and 5 years was 85% versus 96%, 62% vs 82%, 48% vs 72%, 39% vs 62%, and 34% vs
42%, respectively. The relative risk of mortality in nondiabetics (34/176) was
less than that in diabetic patients (71/197): odds ratio (OR) 0.43, 95%
confidence interval (CI) 0.26 – 0.68; p = 0.001. On Cox
regression analysis, diabetes (OR 1.95, 95% CI 1.23 – 3.07; p =
0.004), comorbidities (OR 0.39, 95% CI 0.25 – 0.61; p = 0.001),
peritonitis (OR 1.79, 95% CI 1.19 – 2.68; p = 0.005),
malnutrition (OR 0.52, 95% CI 0.29 – 0.94; p = 0.03), and
residual glomerular filtration rate at initiation of CAPD (OR 0.87, 95% CI
0.81 – 0.93; p = 0.001) were significant predictors of overall
mortality. Age (OR 0.68, 95% CI 0.45 – 1.03; p = 0.07), gender
(OR 0.66, 95% CI 0.42 – 1.03; p = 0.06), and albumin level at
initiation of CAPD (OR 0.92, 95% CI 0.64 – 1.33; p = 0.68) were
not predictors of mortality. Age (56 ± 10 vs 46 ± 15 years,
p = 0.001), comorbidities (51/197 vs 16/176, p = 0.001),
peritonitis rate (0.68 vs 0.50 episodes/patient-year, p = 0.056), and
severe malnutrition (27/197 vs 10/176, p = 0.002) were higher in
diabetic than in nondiabetic patients. Conclusion: In India the majority of CAPD patients are
diabetic. Patient survival was inferior in diabetic compared to nondiabetic
patients on CAPD, but survival was statistically similar after adjustment for
comorbidities. Diabetes, comorbidities, residual glomerular filtration rate,
peritonitis, and severe malnutrition are predictors of mortality in CAPD
patients.
KEY WORDS: India; survival; diabetic; nondiabetic; end-stage renal disease.
Received 25 January 2008; accepted 9 April 2008.
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