Outcome and risk factors for mortality in peritoneal dialysis patients: 22 years of experience in a Turkish center

Abstract

Background: European peritoneal dialysis populations have identified and reported mortality and morbidity risk factors. However, no reports are pointing out the factors affecting the outcomes of these patients during more than 2 decades of follow-up in T & uuml;rkiye. This single -center study aims to evaluate patient mortality and peritonitis rates and estimate confounding factors affecting patient mortality over 22 years. Methods: Adult patients who underwent peritoneal dialysis at our center between December 1994 and December 2016 were enrolled in this retrospective cohort study. The primary outcome of the present study was mortality, and the secondary outcomes were technical failure and peritonitis. Results: Two hundred fifty patients were included in this study. The patients were followed up for a median of 39.5 months (range 17-71). Forty-eight (19.2%) patients died. Survival rates at 5, 10, and 15 years were 86.8% (217/250), 64.6% (86/133), and 41.1% (30/73), respectively. The prevalence of diabetes mellitus [14 (29.2%) vs. 20 (9.9%); P < .001] and cardiovascular disease [16 (33.3%) vs. 24 (11.9%); P < 0.001] were significantly higher in the deceased group compared to the survival group. Cardiovascular disease was the leading cause of death [26 (54.1%)]. Age (hazard ratio (HR) 1.06; 95% CI, 1.04-1.09; P < .001), male sex (HR 2.07; 95% CI, 1.10-3.90; P = .024), and transfer to peritoneal dialysis due to vascular access problems (HR 3.91; 95% CI, 1.90-8.07; P < .001) were associated with mortality in multivariate analysis. Also, catheter exit -site infection, peritonitis rate, catheter removal, and technical complications were similar between the groups. The peritonitis rate was 0.2 episodes per patient per year. Conclusion: The mortality rate of the patient population in our center was similar to Europe and the United States. Cardiovascular diseases and diabetes are the leading causes of death in Turkish peritoneal dialysis patients, as in other populations.