Predictors of Long-Term Survival on Peritoneal Dialysis in South India: A Multicenter Study
Authors: Abraham Georgi , Kumar Vishnu , Nayak Karopadi Shivanand , Ravichandran Rajan , Srinivasan Geetha , Krishnamurthy Magesh , Prasath Arun K. , Kumar Senthil , Thiagarajan Thandavan , Mathew Milly , Lesley Nancy 
Published: February 2010

Background

Little is known about survival on peritoneal dialysis (PD) in Indian patients since the initiation of continuous ambulatory PD (CAPD) in India in 1991. Survival data from single centers with small numbers have been published.

Objective

A retrospective 4-center analysis for predictors of survival >3 years in south Indian chronic PD patients.

Methods

A total of 309 patients were trained during the observation period (from 1999 to 2004) and were analyzed in a multicenter study (4 centers), including 150 patients (male:female 109:41) that survived ≥ 3 years and 59 patients that did not survive ≥ 3 years (nonsurvivors; male: female 43:16) that were taken as controls. The patients were on chronic PD, predominantly CAPD, using double-bag disconnect systems. They were supervised by 4 nephrologists. Mean age in the nonsurvival group was 56.6 ± 10.6 years. In the survival group, mean age was 50.9 ± 14.9 years; there were 92 (62%) nondiabetics and 58 (38%) diabetics; the majority were nonvegetarians; 148 patients were doing 6 – 8 L exchanges and 2 were doing >8 L exchanges daily; 93 of 102 patients were average transporters based on peritoneal equilibration testing. At the beginning, mean combined Kt/V was 2.31 and weekly creatinine clearance was 73 L. Patients making one lifetime payment were 46% and 21% belonged to the full reimbursement group.

Results

Body mass index (BMI) was normal in 114 patients (76%). Ultrafiltration volume was 1377 ± 452 at the start and 1400 ± 461 mL/day after 3 years. Anuric patients at the start were 12% and after 3 years 44%; urine output decreased from 527 ± 26 to 253 ± 14 mL/day from the start to after 3 years. Peritonitis rate was 1 episode/75 patient-months at the beginning and after 3 years it was 1 episode/30 patient-months. Exit-site care was done daily by 88% and 3 times weekly by 12%. Nonsmokers were 92% and smokers were 8%. Those that lived in the city were 62% and rural areas were 38%. Mean blood pressure was 143 ± 16/88 ± 10 and 136 ± 18/85 ± 9 mmHg, calcium × phosphorus product 44.6 ± 15.6 and 45.9 ± 15.7 mg2/dL2, albumin 3.33 ± 0.5 and 3.25 ± 0.4 g/dL, hemoglobin 9.18 ± 2 and 9.48 ± 1.8 g/dL at the beginning and after 3 years, respectively. Statistical analysis showed a significant fall in both systolic ( p ≤ 0.001) and diastolic blood pressure ( p ≤ 0.05), an increase in BMI ( p ≤ 0.01), and a decrease in blood urea ( p ≤ 0.001) in the survival group. Those with Hb ≥ 11 g/dL survived longer ( p ≤ 0.001), those with serum albumin ≥ 3 g/dL had better survival ( p = 0.001), and anuric patients survived longer ( p = 0.001).

Conclusion

This multicenter cohort study of prevalent continuous PD patients in south India showed nondiabetics, average transporters, nonsmokers with reasonable nutritional status, with Hb 11 g/dL, with low peritonitis rate, with over 1 L ultrafiltration volume per day, the great majority that joined the once per lifetime payment scheme, and the reimbursement group survived for 3 years or longer.