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Use of Home Peritoneal Dialysis by Cuba's Nephrology Institute, 2007-2012
Raúl Bohorques1, Yanet Álvarez, Atilano Martínez
1Nephrology Institute (INEF), Havana, Cuba.
Insights
Peritoneal dialysis in Cuba shows promising outcomes for end-stage renal disease patients. This renal replacement therapy achieved international standards, supporting its expanded use in Cuba.
Area of Science:
- Nephrology
- Renal Replacement Therapy
- Public Health
Background:
- Peritoneal dialysis (PD) is a vital maintenance therapy for end-stage renal disease (ESRD).
- Cuba introduced continuous ambulatory PD in 2007 and automated PD in 2008.
- Assessing PD outcomes is crucial for its wider implementation in Cuba.
Purpose of the Study:
- To describe the clinical course of patients in Cuba's Home Peritoneal Dialysis Program.
- To evaluate the effectiveness and complications of PD over five years.
- To provide data for decisions regarding the scale-up of PD in Cuba.
Main Methods:
- An observational, retrospective cohort study was conducted.
- Included 40 patients from Havana's Nephrology Institute treated between December 2007 and December 2012.
- Analyzed patient and peritoneal membrane survival using Kaplan-Meier curves; calculated complication frequencies.
Main Results:
- The study included 40 patients (23 male, 17 female), predominantly aged 40-59.
- Hypertension (42.5%), glomerulopathies (22.5%), and diabetes mellitus (22.5%) were leading causes of ESRD.
- 103 complications occurred: 66% infectious (peritonitis most common) and 34% non-infectious (catheter displacement most common).
- Patient survival was 92% at 5 years; peritoneal membrane function was 88.6% at 5 years.
Conclusions:
- Peritoneal dialysis in Cuba achieved outcomes comparable to international standards.
- The findings support PD as a viable renal replacement therapy for Cuban ESRD patients.
- The study provides evidence for the potential expansion of PD programs in Cuba.
Introduction:
Peritoneal dialysis is a maintenance therapy option for patients with end-stage renal disease. Continuous ambulatory peritoneal dialysis in Cuba was introduced in December 2007, and automated peritoneal dialysis one year later. This paper presents the outcomes attained with this blood purification technique, enabling an assessment to decide on scaling up its use in Cuba.
Objective:
Describe the clinical course of patients in the first five years of the Home Peritoneal Dialysis Program at Havana's Nephrology Institute.
Methods:
An observational, descriptive study with a retrospective cohort was conducted. The universe comprised the 40 Nephrology Institute patients who underwent treatment with home peritoneal dialysis from December 20, 2007 to December 20, 2012. Relative and absolute frequencies were calculated for the study variables and the Kaplan-Meier method was used for survival curves for patients and for the peritoneum as dialysis membrane. RESULTS Of the 40 patients in the program, 23 were men and 17 were women, primarily aged 40 to 59 years. The most frequent causes of chronic kidney failure were hypertension (42.5%), glomerulopathies (22.5%), and diabetes mellitus (22.5%). A total of 103 complications occurred, both infectious (68, 66%) and non-infectious (35, 34%). The most common infectious complication was peritonitis (45, 66.2%); the most frequent non-infectious complication was catheter displacement (13, 37.1%). Seven patients left the peritoneal dialysis program. Of these, three died, two lost function of the peritoneum as a dialysis membrane, one received a kidney transplant and one recovered kidney function. Survival was 100% at one year, 97% at 2 years, 93.2% at 3 and 4 years, and 92% at 5 years. However, the peritoneal membrane was functional in 100% of patients during the first 2 years, decreasing to 96% at 3 and 4 years and to 88.6% at 5 years.
Conclusions:
In our setting, peritoneal dialysis attained outcomes similar to those obtained internationally, which supports its usefulness as a renal replacement therapy method in Cuban patients with end-stage renal disease.