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Pre-dialysis renal clinic visits and patients' outcomes on peritoneal dialysis
Wen Tang1, Xiu-Hong Hu1,2,3, Lei Zhu1,4
1Division of Nephrology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, China.
Insights
Frequent pre-dialysis renal clinic visits improve outcomes for peritoneal dialysis (PD) patients in China. This care reduces mortality and technical failure, highlighting the need for better chronic kidney disease management.
Area of Science:
- Nephrology
- Public Health
- Clinical Medicine
Background:
- Chronic kidney disease (CKD) management is crucial for patients progressing to end-stage renal disease.
- Peritoneal dialysis (PD) is a common renal replacement therapy.
- Effective pre-dialysis care can significantly impact PD patient outcomes.
Purpose of the Study:
- To investigate the impact of pre-dialysis renal care frequency on patient outcomes in China.
- To determine if frequent renal clinic visits before initiating PD are associated with improved results.
Main Methods:
- Retrospective cohort study of 668 patients initiating PD between 2006 and 2014.
- Patients divided into two groups: frequent renal clinic visits (Group A) and infrequent visits (Group B).
- Medical charts reviewed for demographic and clinical data; outcomes analyzed using Cox regression.
Main Results:
- Frequent pre-dialysis visits (Group A) were linked to fewer emergency room admissions before PD initiation compared to Group B (33% vs. 42.7%).
- Group A showed significantly lower mortality rates (p=0.003) and technical failure rates (p<0.01) on PD.
- Multivariable analysis confirmed frequent visits associated with reduced mortality (HR 0.62) and technical failure (HR 0.58).
Conclusions:
- Frequent pre-dialysis renal clinic visits are associated with better outcomes for PD patients.
- Current pre-dialysis management in the studied cohort was suboptimal.
- An organized system for managing CKD patients before dialysis initiation is necessary in China.
Purpose:
To investigate the effect of pre-dialysis renal care on peritoneal dialysis (PD) patients' outcomes in China.
Methods:
In this retrospective cohort study, patients who started PD during January 1, 2006, to December 31, 2014, were included. Patients' medical charts were reviewed to extract the information. To explore the effect of pre-dialysis renal care on patients' outcomes, patient were divided into two groups according to whether or not they had frequent renal clinic visits: Group A (with frequent visits) and Group B (without frequent visits).
Results:
A total of 668 patients were included. Patients who admitted to emergency room before PD initiations were significantly higher in Group B than in Group A (42.7 vs. 33 %, p = 0.01). However, there was no significant difference in the proportion of patients requiring emergency hemodialysis prior to PD commencement (20.5 vs. 24.6 %, p = 0.21), acute heart failure (30.2 vs. 35.4 %, p = 0.16) and pulmonary infection (15.4 vs. 12.1 %, p = 0.23) between groups. Both the mortality and technical failure rate in Group A were significantly lower as compared to Group B (p = 0.003 and p < 0.01, respectively). Multivariable Cox regression analysis showed frequent pre-dialysis renal clinic visits were associated with both lower mortality rate (HR 0.62, 95 % CI 0.46-0.85, p = 0.003) and technical failure on PD (HR 0.58, 95 % CI 0.36-0.92, p = 0.022).
Conclusion:
Pre-dialysis frequent clinic visits were associated with better PD outcomes. Pre-dialysis renal clinic management was suboptimal in the present cohort. More organized system to ensure people with established chronic kidney disease are well managed is necessary in China.
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