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PD IN THE DEVELOPING WORLD |
Madras Medical Mission,1 Chennai; Pondicherry Institute of Medical Sciences2 ; Clinical Team,3 Chennai Baxter; Global Hospital,4 Hyderabad; Madras Institute of Nephrology5 ; Sri Ramachandra University,6 Chennai, India
Correspondence to: G. Abraham, SRMC, Madras Medical Mission, No. 9/2, 15th Ave., Harrington Rd, Chetpet 600 031 India. abraham_georgi{at}yahoo.com
Background: Little is known about survival on
peritoneal dialysis (PD) in Indian patients since the initiation of continuous
ambulatory PD (CAPD) in India in 1991. Survival data from single centers with
small numbers have been published. Objective: A retrospective 4-center analysis for
predictors of survival >3 years in south Indian chronic PD
patients. Methods: A total of 309 patients were trained during
the observation period (from 1999 to 2004) and were analyzed in a multicenter
study (4 centers), including 150 patients (male:female 109:41) that survived
3 years and 59 patients that did not survive 3 years (nonsurvivors;
male: female 43:16) that were taken as controls. The patients were on chronic
PD, predominantly CAPD, using double-bag disconnect systems. They were
supervised by 4 nephrologists. Mean age in the nonsurvival group was 56.6
± 10.6 years. In the survival group, mean age was 50.9 ± 14.9
years; there were 92 (62%) nondiabetics and 58 (38%) diabetics; the majority
were nonvegetarians; 148 patients were doing 6 – 8 L exchanges and 2
were doing >8 L exchanges daily; 93 of 102 patients were average
transporters based on peritoneal equilibration testing. At the beginning, mean
combined Kt/V was 2.31 and weekly creatinine clearance was 73 L. Patients
making one lifetime payment were 46% and 21% belonged to the full
reimbursement group. Results: Body mass index (BMI) was normal in 114
patients (76%). Ultrafiltration volume was 1377 ± 452 at the start and
1400 ± 461 mL/day after 3 years. Anuric patients at the start were 12%
and after 3 years 44%; urine output decreased from 527 ± 26 to 253
± 14 mL/day from the start to after 3 years. Peritonitis rate was 1
episode/75 patient-months at the beginning and after 3 years it was 1
episode/30 patient-months. Exit-site care was done daily by 88% and 3 times
weekly by 12%. Nonsmokers were 92% and smokers were 8%. Those that lived in
the city were 62% and rural areas were 38%. Mean blood pressure was 143
± 16/88 ± 10 and 136 ± 18/85 ± 9 mmHg, calcium
x phosphorus product 44.6 ± 15.6 and 45.9 ± 15.7
mg2/dL2, albumin 3.33 ± 0.5 and 3.25 ± 0.4
g/dL, hemoglobin 9.18 ± 2 and 9.48 ± 1.8 g/dL at the beginning
and after 3 years, respectively. Statistical analysis showed a significant
fall in both systolic (p 
0.001) and diastolic blood pressure
(p 0.05), an increase in BMI (p 0.01), and a
decrease in blood urea (p 0.001) in the survival group. Those
with Hb 11 g/dL survived longer (p 0.001), those with serum
albumin 3 g/dL had better survival (p = 0.001), and anuric
patients survived longer (p = 0.001). Conclusion: This multicenter cohort study of prevalent
continuous PD patients in south India showed nondiabetics, average
transporters, nonsmokers with reasonable nutritional status, with Hb 11 g/dL,
with low peritonitis rate, with over 1 L ultrafiltration volume per day, the
great majority that joined the once per lifetime payment scheme, and the
reimbursement group survived for 3 years or longer.
KEY WORDS: South Indian PD patients; survival > 3 years; predictors of survival.
Received 29 January 2008; accepted 8 October 2009.
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