Reasons And Risk Factors For The Dropout Of Peritoneal Dialysis Patients

Objective: A number of studies have shown that the withdrawal rates of peritoneal dialysis(PD)patients,accompanied with withdrawal reasons,vary in different PD centers.This study aims to explore the reasons and risk factors for PD withdrawal in our hospital.Methods: This was a single-center,retrospective cohort study.Patients who started PD in the Department of Nephrology of the First Affiliated Hospital of Nanchang University from November 1st,2005 to February 28 th,2017,were enrolled,and followed-up to May 31,2017.According to the inclusion and exclusion criteria,patients were screened strictly.Patients who continued PD until May 31,2017 were regarded as the control group.Patients who withdrew from PD were divided into 4 subgroups:death group,hemodialysis group,kidney transplantation group and loss of follow-up group.The clinical characters of 4 subgroups were compared with the control group.At the same time,the withdrawal group was compared with the control group to analyze the risk factors affecting the PD withdrawal.Results: A total of 998 patients with 570 males and 428 females were enrolled,the average age of whom when PD commencement was(49.36±14.94),and the median PD duration was 27.13(12.84,42.29)months.The main primary disease was glomerulonephritis(64.93%),followed by diabetic nephropathy(16.23%).73.15% had hypertension,19.14% had diabetes and 10.02% had cardio-cerebro-vascular diseases in the enrolled patients.517 dropout events were recorded,and the dropout rate was 51.80%.The main reason for withdrawal from PD was death(258 patients,49.90%),followed by hemodialysis(166 patients,32.11%),kidney transplantation(66 patients,12.77%)and loss to follow-up(27 patients,5.22%).The leading cause of death was cardio-cerebro-vascular diseases(136 cases,52.7l%),followed by infection(42 cases,16.28%),dyscrasia(20 cases,7.75%)and tumor(5 cases,1.94%).The main reason for transfering to hemodialysis was insufficient dialysis(76 cases,45.78%),followed by peritonitis(55 cases,33.13%)and catheter dysfunction(24 cases,14.46%).Compared with those in the control group,patients in the death group were older at PD commencement,and had higher proportions of hypertension,diabetes and cardiocerebro-vascular diseases(all P <0.05).The proportions of male and diabetes mellitus were higher in the hemodialysis group than those in the control group(both P< 0.05).Biochemical indicators showed that serum albumin and blood phosphorus were lower in the death group than those in the control group(both P<0.05);blood albumin was significantly lower in the hemodialysis group than that in the control group(P<0.05).Multivariate COX regression model analysis showed that male,low education,advanced age,diabetes,low albumin,and low uric acid were risk factors of withdrawal from peritoneal dialysis.Conclusions: The main reasons for withdrawal from PD in our center are death and transfering to hemodialysis.The cardio-cerebro-vascular diseases is the leading cause of death,and inadequate dialysis is the main reason for transfering to hemodialysis.Male,low education,advanced age,diabetes and low albumin were risk factors of withdrawal from peritoneal dialysis.