CHAPTER 12 Peritoneal Dialysis
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Transcript of CHAPTER 12 Peritoneal Dialysis
CHAPTER 12Peritoneal Dialysis
Sunita Bavanandan
Lily Mushahar
Anita Bhajan Manocha
Source: 20th MDTR Report 2012, NRR
Table 12.1.1: Peritoneal dialysis regimes, 1997-2012
PD regime2003 2004 2005 2006 2007
n % n % n % n % n %
Standard CAPD 1192 96.1 1266 96.8 1303 93.2 1397 90 1547 85.7
DAPD 34 3 39 2.8 45 3.2 67 4.3 115 6.4
Automated PD/ CCPD 5 0.9 12 0.4 50 3.6 88 5.7 144 8
TOTAL 1231 100 1317 100 1398 100 1552 100 1806 100
PD regime2008 2009 2010 2011 2012
n % n % n % n % n %
Standard CAPD 1717 82.4 1847 83.5 1973 83.6 2079 79.7 2320 80
DAPD 121 5.8 119 5.4 91 3.9 117 4.5 140 4.8
Automated PD/ CCPD 245 11.8 246 11.1 296 12.5 414 15.9 439 15.1
TOTAL 2083 100 2212 100 2360 100 2610 100 2899 100
Source: 20th MDTR Report 2012, NRR
Table 12.1.2: PD System, 1997-2012
PD System2003 2004 2005 2006 2007
n % n % n % n % n %
Baxter disconnect 1048 88.8 1147 87 1286 92.1 1425 92 1675 93.5
Fresenius disconnect 154 11.2 145 12.8 111 7.9 119 7.7 116 6.5
Others 3 0 0 0.2 0 0 5 0.3 0 0
TOTAL 1205 100 1292 100 1397 100 1549 100 1791 100
PD System 2008 2009 2010 2011 2012
n % n % n % n % n %
Baxter disconnect 1955 93.9 2013 92.1 2126 90.7 2230 85.8 2325 80.1
Fresenius disconnect 124 6 173 7.9 218 9.3 367 14.1 578 19.9
Others 4 0.2 0 0 1 0 1 0 1 0
TOTAL 2083 100 2186 100 2345 100 2598 100 2904 100
Source: 20th MDTR Report 2012, NRR
Table 12.1.3a: CAPD Number of Exchanges per day, 1997-2012
Number of exchanges/ day
2003 2004 2005 2006 2007
n % n % n % n % n %
2 3 0.5 6 0 3 0.2 3 0.2 2 0.1
3 14 1 12 1.2 20 1.5 52 3.7 29 1.9
4 1104 94.8 1185 95.9 1234 95.1 1296 93.2 1456 95.8
5 30 3.8 47 2.9 40 3.1 39 2.8 33 2.2
TOTAL 1151 100 1250 100 1297 100 1390 100 1520 100
Number of exchanges/ day
2008 2009 2010 2011 2012
n % n % n % n % n %
2 3 0.2 2 0.1 7 0.4 1 0 10 0.4
3 47 2.8 79 4.4 125 6.4 113 5.5 139 6.1
4 1611 94.4 1676 92.3 1778 91.1 1874 91.3 2064 90.2
5 46 2.7 59 3.2 42 2.2 65 3.2 75 3.3
TOTAL 1707 100 1816 100 1952 100 2053 100 2288 100
Source: 20th MDTR Report 2012, NRR
Table 12.1.3b: APD dwell volumes per day, 1997-2012
Dwell volumes/ day
2003 2004 2005 2006 2007
n % n % n % n % n %
8 0 0 0 0 9 47.4 6 12.5 11 10.5
10 1 100 4 100 7 36.8 32 66.7 83 79
12 0 0 0 0 3 15.8 10 20.8 10 9.5
14 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 1 1
TOTAL 1 100 4 100 19 100 48 100 105 100
Dwell volumes/ day
2008 2009 2010 2011 2012
n % n % n % n % n %
8 4 2.2 7 5.1 11 14.5 9 3.7 18 12.3
10 164 92.1 119 87.5 56 73.7 222 90.6 108 74
12 10 5.6 8 5.9 8 10.5 11 4.5 17 11.6
14 0 0 0 0 0 0 0 0 0 0
16 0 0 2 1.5 1 1.3 3 1.2 3 2.1
TOTAL 178 100 136 100 76 100 245 100 146 100
Source: 20th MDTR Report 2012, NRR
Table 12.2.1: Distribution of delivered Kt/V, PD patients 2003-2012
YearNumber of
PatientsMean SD Median LQ UQ
% patients ≥ 1.7 per week
2003 763 2.1 0.5 2.1 1.8 2.5 83
2004 1038 2.1 0.5 2.1 1.8 2.4 85
2005 1092 2.1 0.5 2.1 1.8 2.4 83
2006 1266 2.1 0.5 2.1 1.8 2.4 84
2007 1412 2.1 0.5 2.1 1.8 2.4 83
2008 1679 2.1 0.5 2 1.8 2.4 82
2009 1837 2.1 0.5 2 1.8 2.4 81
2010 1913 2.1 0.5 2 1.7 2.3 79
2011 1787 2.1 0.5 2 1.8 2.3 79
2012 2335 2.1 0.5 2 1.8 2.3 79
Source: 20th MDTR Report 2012, NRR
Figure 12.2.1: Cumulative distribution of delivered Kt/V, PD patients 1997-2012
Source: 20th MDTR Report 2012, NRR
0
.25
.5
.75
1
Cum
ulat
ive
dist
ribu
tion
1 1.2 1.4 1.6 1.8 2 2.2 2.4 2.6 2.8 3 3.2KT/V
2012 2011 2010 20092008 2007 2006 20052004 2003
Table 12.2.2: Variation in proportion of patients with Kt/V 1.7 per week among PD centres, 1997-2012
YearNumber of
centresMin 5th Centile LQ Median UQ
95th Centile
Max
2003 14 0 0 75 82.5 88 91 91
2004 17 75 75 79 85 88 100 100
2005 18 56 56 75 85 89 96 96
2006 20 66 66 78 82.5 91.5 100 100
2007 21 25 69 78 85 89 93 93
2008 20 33 50.5 76.5 80 89 93.5 96
2009 21 48 63 76 83 89 97 100
2010 22 48 59 73 79 86 90 94
2011 24 61 64 70.5 78.5 82.5 90 91
2012 25 53 59 70 79 87 95 100
Source: 20th MDTR Report 2012, NRR
Figure 12.2.2: Variation in proportion of patients with Kt/V 1.7 per week among PD centres
Source: 20th MDTR Report 2012, NRR
0
10
20
30
40
50
60
70
80
90
100
% p
atie
nts
0 2 4 6 8 10 12 14 16 18 20 22 24Centre
(lower 95% CI, upper 95% CI)% with KT/V >=1.7 per week
Table 12.2.3: Peritoneal transport status by PET D/P creatinine at 4 hours, new PD patients 2004-2012
Source: 20th MDTR Report 2012, NRR
Table 12.2.4: Peritoneal Transport Status (PET) with dialysis vintage
Duration (Years)
<1 1-<2 2-<3 3-<4 4-<5
n % n % n % n % n %
Low 53 12 49 10 34 12 24 10 12 8
Low average 190 43 173 36 116 40 88 37 74 48
High average 157 35 193 41 112 39 103 43 47 31
High 47 11 60 13 28 10 23 10 20 13
TOTAL 447 100 475 100 290 100 238 100 153 100
Duration (Years)
5-<6 6-<7 7-<8 8-<9 9-<10 10 or more
n % n % n % n % n % n %
Low 6 6 9 13 3 6 4 12 1 3 4 10
Low average 51 49 26 39 21 45 10 29 10 32 9 21
High average 37 35 26 39 19 40 19 56 19 61 20 48
High 11 10 6 9 4 9 1 3 1 3 9 21
TOTAL 105 100 67 100 47 100 34 100 31 100 42 100
Source: 20th MDTR Report 2012, NRR
Table 12.3.1(a): Unadjusted technique survival by age (uncensored for death and transplant), 1997-2012
Source: 20th MDTR Report 2012, NRR
Figure 12.3.1(a): Unadjusted technique survival by age (uncensored for death and transplant), 1997-2012
Source: 20th MDTR Report 2012, NRR
Age>=65Age 55-64Age 45-54Age 35-44Age 25-34Age 15-24Age 1-14
0.00
0.20
0.40
0.60
0.80
1.00
Cum
ula
tive
surv
ival
0 24 48 72 96 120 144 168 192 216 240Duration in months
Kaplan-Meier survival estimates, by Age
Table 12.3.1(b): Unadjusted technique survival by age (censored for death and transplant), 1997-2012
Source: 20th MDTR Report 2012, NRR
Figure 12.3.1(b): Unadjusted technique survival by age (censored for death and transplant), 1997-2012
Source: 20th MDTR Report 2012, NRR
Age>=65
Age 55-64
Age 45-54Age 35-44Age 25-34Age 15-24
Age 1-14
0.00
0.20
0.40
0.60
0.80
1.00
Cum
ulat
ive
surv
ival
0 24 48 72 96 120 144 168 192 216 240Duration in months
Kaplan-Meier survival estimates, by Age
Table 12.3.2(a): Unadjusted technique survival by gender (uncensored for death and transplant), 1997-2012
Gender Interval (months)
Male Female
n % survival SE n % survival SE
0 4014 100 3906 100
6 3395 90 0 3315 90 0
12 2753 79 1 2755 80 1
24 1798 60 1 1895 63 1
36 1181 44 1 1300 49 1
48 741 32 1 868 38 1
60 468 24 1 608 31 1
72 305 18 1 412 24 1
84 183 13 1 275 19 1
96 111 9 1 179 14 1
108 69 7 1 119 12 1
120 37 5 1 70 9 1
Source: 20th MDTR Report 2012, NRR
Figure 12.3.2(a): Unadjusted technique survival by gender (uncensored for death and transplant), 1997-2012
Source: 20th MDTR Report 2012, NRR
Male
Female
0.00
0.25
0.50
0.75
1.00
Cum
ulat
ive
surv
ival
0 24 48 72 96 120 144 168 192 216 240Duration in months
Kaplan-Meier survival estimates, by sex
Table 12.3.2(b): Unadjusted technique survival by gender (censored for death and transplant), 1997-2012
Gender Interval (months)
Male Female
n % survival SE n % survival SE
0 4014 100 3906 100
6 3395 97 0 3315 97 0
12 2753 93 0 2755 94 0
24 1798 85 1 1895 87 1
36 1181 78 1 1300 79 1
48 741 71 1 868 73 1
60 468 63 1 608 68 1
72 305 57 1 412 64 1
84 183 50 2 275 58 2
96 111 46 2 179 52 2
108 69 42 2 119 49 2
120 37 34 3 70 43 2
Source: 20th MDTR Report 2012, NRR
Figure 12.3.2(b): Unadjusted technique survival by gender (censored for death and transplant), 1997-2012
Source: 20th MDTR Report 2012, NRR
Male
Female
0.00
0.25
0.50
0.75
1.00
Cum
ulat
ive
surv
ival
0 24 48 72 96 120 144 168 192 216 240Duration in months
Kaplan-Meier survival estimates, by sex
Table 12.3.3(a): Unadjusted technique survival by diabetes status (uncensored for death and transplant), 1997-2012
Diabetes statusInterval (month)
Non-diabetic Diabetic
n % survival SE n % survival SE
0 4729 100 3191 100
6 4035 92 0 2675 88 1
12 3369 83 1 2139 75 1
24 2351 68 1 1342 52 1
36 1688 56 1 790 33 1
48 1175 45 1 432 22 1
60 845 37 1 231 14 1
72 598 30 1 119 9 1
84 395 23 1 63 5 1
96 259 17 1 33 3 1
108 173 14 1 15 2 0
120 101 11 1 6 1 0
Source: 20th MDTR Report 2012, NRR
Figure 12.3.3(a): Unadjusted technique survival by Diabetes status (uncensored for death and transplant), 1997-2012
Source: 20th MDTR Report 2012, NRR
Diabetic
Non-diabetic
0.00
0.25
0.50
0.75
1.00
Cum
ulat
ive
surv
ival
0 24 48 72 96 120 144 168 192 216 240Duration in months
Kaplan-Meier survival estimates, by Diabetes
Table 12.3.3(b): Unadjusted technique survival by diabetes status (censored for death and transplant), 1997-2012
Diabetes statusInterval (month)
Non- diabetes Diabetic
n % survival SE n % survival SE
0 4729 100 3191 100
6 4035 97 0 2675 97 0
12 3369 93 0 2139 93 0
24 2351 86 1 1342 85 1
36 1688 79 1 790 77 1
48 1175 72 1 432 72 1
60 845 66 1 231 67 2
72 598 61 1 119 62 2
84 395 54 1 63 57 3
96 259 48 1 33 54 3
108 173 45 2 15 48 5
120 101 38 2 6 43 7
Source: 20th MDTR Report 2012, NRR
Figure 12.3.3(b): Unadjusted technique survival by diabetes status (censored for death and transplant), 1997-2012
Source: 20th MDTR Report 2012, NRR
Diabetic
Non-diabetic
0.00
0.25
0.50
0.75
1.00
Cum
ulat
ive
surv
ival
0 24 48 72 96 120 144 168 192 216 240Duration in months
Kaplan-Meier survival estimates, by Diabetes
Table 12.3.4: Unadjusted technique survival by Kt/V, 1997-2012
Kt/V Interval (months)
<1.7 1.7-2.0 >2.0
n % Survival SE n % Survival SE n % Survival SE
0 2796 100 3975 100 8131 100
6 2713 98 0 3877 98 0 7963 99 0
12 2528 94 0 3666 95 0 7514 96 0
24 2104 84 1 3162 87 1 6393 87 0
36 1663 71 1 2625 76 1 5171 77 0
48 1228 59 1 2038 65 1 3996 66 1
60 858 47 1 1515 54 1 3093 57 1
72 616 38 1 1150 47 1 2305 50 1
84 415 29 1 779 37 1 1629 42 1
96 309 25 1 503 29 1 1190 35 1
108 202 20 1 345 23 1 846 30 1
120 135 18 1 205 18 1 481 24 1
Source: 20th MDTR Report 2012, NRR
Figure 12.3.4: Unadjusted technique survival by Kt/V,1997-2012
Source: 20th MDTR Report 2012, NRR
Kt/V >2.0Kt/V 1.7-2.0Kt/V <1.7
0.00
0.25
0.50
0.75
1.00C
umul
ativ
e su
rviv
al
0 24 48 72 96 120 144 168Duration in months
Kaplan-Meier survival estimates, by KTV
Table 12.3.5: Adjusted hazard ratio for change of modality, 1997-2012
Source: 20th MDTR Report 2012, NRR
Table 12.3.6: Reasons for drop-out from PD program, 2003-2012
Source: 20th MDTR Report 2012, NRR
Table 12.3.7: Drop-out rate from PD program with time on treatment, 2003-2012
Source: 20th MDTR Report 2012, NRR
Table 12.3.8: Time on PD (1997-2012)
Source: 20th MDTR Report 2012, NRR
Table 12.4.1 Variation in peritonitis rate (patient-month/episode) among PD centres, 1997-2012
YearNumber of
centresMin 5th Centile LQ Median UQ 95th Centile Max
1997 9 6 6 13.5 16.1 23.2 30 30
1998 9 0 0 17.7 23.5 29.1 54.9 54.9
1999 9 14.3 14.3 16.3 19.3 21 31.5 31.5
2000 11 11.7 11.7 17.4 23.2 30.6 71.4 71.4
2001 11 10.8 10.8 19.9 23.6 41.4 60.3 60.3
2002 11 12.6 12.6 17.9 32.7 44.4 219.2 219.2
2003 13 18.2 18.2 21.3 32.9 39.6 312.1 312.1
2004 15 0 0 23.6 32.9 36.6 41.5 41.5
2005 15 18 18 26.3 35.8 43 58 58
2006 21 14.8 18.5 27 37.9 49.8 65.2 97.7
2007 23 12 12.9 31.2 42.1 55.3 66.9 106.7
2008 25 12 13 30 40.4 58.7 105.5 114.6
2009 25 14 17.6 29.5 38.2 55.7 117.7 246.1
2010 26 10.8 19.3 28.1 36 52.3 72.2 84.9
2011 28 8.9 12 33.8 46 63.5 103.9 260.1
2012 27 25.5 34.8 44.3 53.8 73.5 170 249.1
Source: 20th MDTR Report 2012, NRR
Figure 12.4.1 Variation in peritonitis rate among PD centres, 2012
Source: 20th MDTR Report 2012, NRR
0
200
400
600
800
1000
Rat
e, p
t-m
onth
/epi
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28Centre
(lower 95% CI, upper 95% CI)Peritonitis rate
Table 12.4.2: Causative organism in PD peritonitis, 2003-2012
Source: 20th MDTR Report 2012, NRR
Figure12.4.2 Causative organism in PD peritonitis, 2001-2012
0
50
100
150
200
250
300
350
400
Frequency
'01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12
Staph. Aureus Staph coagulase neg.
Other gram positive Pseudomonas
E.Coli Polymicrobial
Fungal Mycobacterium
Culture negative
Source: 20th MDTR Report 2012, NRR
Figure 12.4.3(a): Outcome of peritonitis by causative organism, 2012
63.49%20.44%
16.07%
Resolved Not resolved, catheter removedDeath
Outcome of peritonitis in 2012
Source: 20th MDTR Report 2012, NRR
Table 12.4.3(a): Outcome of peritonitis by causative organism, 1993-2002
Causative Organism ResolvedNot resolved,
catheter removed
Death Total
n % n % n % n %
(A) Gram Positives
Staph. Aureus 150 69 23 11 44 20 217 100
Staph Coagulase Neg. 135 78 11 6 26 15 172 100
Streptococcus 35 66 5 9 13 25 53 100
Others 11 58 2 11 6 32 19 100
(B) Gram Negatives
Pseudomonas 36 38 28 29 32 33 96 100
Acinetobacter 44 61 10 14 18 25 72 100
Klebsiella 30 45 15 22 22 33 67 100
Enterobacter 27 54 10 20 13 26 50 100
E.Coli 43 61 3 4 24 34 70 100
Others 15 56 3 11 9 33 27 100
(C) Polymicrobial 11 25 14 32 19 43 44 100
(D) Others
Fungal 5 5 44 43 54 52 103 100
Mycobacterium 6 27 6 27 10 45 22 100
Others 7 54 3 23 3 23 13 100
(E) No growth 555 71 94 12 133 17 782 100Source: 20th MDTR Report 2012, NRR
Figure 12.4.3(b): Outcome of peritonitis by causative organism, 1993-2002
0
20
40
60
80
100
Per
cen
t (%
)
Sta
ph.
Aur
eus
Sta
ph C
oagu
lase
Neg
.
Str
ep
Oth
ers
Pse
udo
mon
as
Aci
neto
bact
er
Kle
bsi
ella
Ent
ero
bact
er
E.C
oli
Oth
ers
Pol
ymic
robi
al
Fun
gal
Myc
obac
teriu
m
Oth
ers
No
gro
wth
Resolved Not resolved, catheter removed Death
Source: 20th MDTR Report 2012, NRR
Table 12.4.3(b): Outcome of peritonitis by causative organism, 2003-2012
Causative OrganismResolved
Not resolved, catheter removed
Death Total
n % n % n % n %
(A) Gram Positives
Staph. Aureus 386 67 92 16 97 17 575 100
Staph Coagulase Neg. 358 80 30 7 59 13 447 100
Strep 153 81 13 7 24 13 190 100
Others 82 78 10 10 13 12 105 100
(B) Gram Negatives
Pseudomonas 102 35 83 28 109 37 294 100
Acinetobacter 107 58 34 18 45 24 186 100
Klebsiella 126 57 40 18 56 25 222 100
Enterobacter 51 58 11 13 26 30 88 100
E.Coli 222 62 45 13 93 26 360 100
Others 42 55 21 28 13 17 76 100
(C) Polymicrobial 10 32 6 19 15 48 31 100
(D) Others
Fungal 10 6 53 31 107 63 170 100
Mycobacterium 2 7 8 29 18 64 28 100
Others 108 62 29 17 38 22 175 100
(E) No growth 929 68 166 12 268 20 1363 100
Source: 20th MDTR Report 2012, NRR
Figure 12.4.3(c): Outcome of peritonitis by causative organism, 2003-2012
Source: 20th MDTR Report 2012, NRR
0
20
40
60
80
100
Per
cent
(%
)
Sta
ph. A
ureu
s
Sta
ph C
oagu
lase
Neg
.
Str
ep
Oth
ers
Pse
udom
onas
Aci
neto
bact
er
Kle
bsie
lla
Ent
erob
acte
r
E.C
oli
Oth
ers
Pol
ymic
robi
al
Fun
gal
Myc
obac
teriu
m
Oth
ers
No
grow
th
Resolved Not resolved, catheter removed Death
Figure 12.4.3(d): Comparing outcome of peritonitis by causative organism in 1993-2002 vs 2003-2012
0
20
40
60
80
100
Pe
rce
nt
(%)
Sta
ph
. A
ure
us
Sta
ph
Co
ag
ula
se N
eg
.
Str
ep
Oth
ers
Pse
ud
om
on
as
Aci
ne
tob
act
er
Kle
bsi
ella
En
tero
ba
cte
r
E.C
oli
Oth
ers
Po
lym
icro
bia
l
Fu
ng
al
Myc
ob
act
eriu
m
Oth
ers
No
gro
wth
19
93
-02
20
03
-12
19
93
-02
20
03
-12
19
93
-02
20
03
-12
19
93
-02
20
03
-12
19
93
-02
20
03
-12
19
93
-02
20
03
-12
19
93
-02
20
03
-12
19
93
-02
20
03
-12
19
93
-02
20
03
-12
19
93
-02
20
03
-12
19
93
-02
20
03
-12
19
93
-02
20
03
-12
19
93
-02
20
03
-12
19
93
-02
20
03
-12
19
93
-02
20
03
-12
Resolved Not resolved, catheter removed Death
Source: 20th MDTR Report 2012, NRR
Table 12.4.4: Risk factors influencing peritonitis rate, 1993-2012
Source: 20th MDTR Report 2012, NRR