Long-term peritoneal dialysis experience in Portugal

Area of Science:

• Nephrology
• Renal Replacement Therapy
• Dialysis Techniques

Background:

• Peritoneal dialysis (PD) utilization varies globally, with Portugal showing underutilization.
• Indications and outcomes for PD therapy have evolved significantly.
• Long-term data on PD programs in Portugal are limited.

Purpose of the Study:

• To evaluate the outcomes of a 20-year peritoneal dialysis program in Portugal.
• To assess patient and technique survival rates and identify factors influencing them.
• To analyze trends in PD utilization and patient preference over two decades.

Main Methods:

• Retrospective analysis of 312 patients over a 20-year PD program.
• Evaluation of Tenckhoff catheter survival, patient survival, and technique survival.
• Analysis of reasons for PD discontinuation, including transfer to hemodialysis (HD), death, and transplantation.
• Assessment of peritonitis rates and hospital admission data.

Main Results:

• Patient preference for PD significantly increased from 33% to 47% over the two decades.
• Cumulative patient survival was 91%, 74%, and 55% at 1, 3, and 5 years, respectively.
• Catheter survival improved in the last decade (85.7%, 69.6%, 54.8% at 1, 3, 5 years).
• Peritonitis rates decreased to 1 episode/30 patient-months, and hospital admissions reduced to 4.8 days/patient-year.
• Main reasons for transfer to HD were peritonitis and access-related infections (35%); cardiovascular events caused 58% of deaths.

Conclusions:

• Peritoneal dialysis is an effective renal replacement therapy in Portugal, with improving outcomes and growing patient acceptance.
• Enhanced technical solutions and increased experience have led to better PD program results.
• Addressing peritonitis and cardiovascular events remains crucial for optimizing PD patient outcomes.