Achieving better results for peritoneal dialysis in recent years
Logrando mejores resultados para la diálisis peritoneal en los últimos años
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Campistol" "autores" => array:19 [ 0 => array:2 [ "nombre" => "Francisco" "apellidos" => "Maduell" ] 1 => array:2 [ "nombre" => "Néstor" "apellidos" => "Rodriguez" ] 2 => array:2 [ "nombre" => "Néstor" "apellidos" => "Rodríguez" ] 3 => array:2 [ "nombre" => "Marta" "apellidos" => "Arias Guillén" ] 4 => array:2 [ "nombre" => "Marta" "apellidos" => "Arias-Guillén" ] 5 => array:2 [ "nombre" => "Sonia" "apellidos" => "Jimenez" ] 6 => array:2 [ "nombre" => "Sonia" "apellidos" => "Jiménez" ] 7 => array:2 [ "nombre" => "Belen" "apellidos" => "Alemany" ] 8 => array:2 [ "nombre" => "Belén" "apellidos" => "Alemany" ] 9 => array:2 [ "nombre" => "Carlos" "apellidos" => "Durán" ] 10 => array:2 [ "nombre" => "Néstor" "apellidos" => "Fontseré" ] 11 => array:2 [ "nombre" => "Manel" "apellidos" => "Vera" ] 12 => array:2 [ "nombre" => "Montserrat" "apellidos" => "Carrera" ] 13 => array:2 [ "nombre" => "Carola" "apellidos" => "Arcal" ] 14 => array:2 [ "nombre" => "Nuria" "apellidos" => "Pérez" ] 15 => array:2 [ "nombre" => "Aleix" "apellidos" => "Cases" ] 16 => array:2 [ "nombre" => "Aleix" "apellidos" => "Cases" ] 17 => array:2 [ "nombre" => "Josep M" "apellidos" => "Campistol" ] 18 => array:2 [ "nombre" => "Josep M." "apellidos" => "Campistol" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699512001982" "doi" => "10.3265/Nefrologia.pre2012.May.11391" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512001982?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325141200198X?idApp=UINPBA000064" "url" => "/20132514/0000003200000005/v0_201502091606/X201325141200198X/v0_201502091606/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "titulo" => "Achieving better results for peritoneal dialysis in recent years" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "587" "paginaFinal" => "596" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Pedro L. Quirós-Ganga, César Remón-Rodríguez" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Pedro L." "apellidos" => "Quirós-Ganga" "email" => array:1 [ 0 => "pedrol.quiros.sspa@juntadeandalucia.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "nombre" => "César" "apellidos" => "Remón-Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario Puerto Real, Cádiz, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Logrando mejores resultados para la diálisis peritoneal en los últimos años" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11456_16025_35219_en_f111456_copy1.jpg" "Alto" => 880 "Ancho" => 1016 "Tamanyo" => 295139 ] ] "descripcion" => array:1 [ "en" => "Incident patients in peritoneal dialysis per year" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION AND OBJECTIVES</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">As it is well known through the latest publications and comparative analysis, survival rate between haemodialysis (HD) and peritoneal dialysis (PD) techniques are the same, with similar long-term results, but the associated comorbidity factors have a great impact on the mortality rates of dialysis patients.<span class="elsevierStyleSup">1-3 </span>Advanced age, diabetes mellitus and complications arising from arteriosclerosis seem to be definitive influencing factors and may explain with a wide enough margin most deaths in the multivariate models, therefore, having more connection with survival rate than with dialysis itself.<span class="elsevierStyleSup">4,5</span></p><p class="elsevierStylePara">However, PD is used much less than it would be expected on the light of such publications.<span class="elsevierStyleSup">6</span> Medical and, what is more concerning, non-medical factors, such as financing and knowledge and experience of each medical unit or centre, may have influenced this matter. Nonetheless, in the most recent studies prognosis for PD has improved proportionately more than that of HD,<span class="elsevierStyleSup">7-9</span> yet this has not meant an increase in the usage of this treatment.</p><p class="elsevierStylePara">The primary objective of the present study focuses, therefore, in determining whether PD has improved over time, within our environment, with respect to results in both patient survival and technique during two study periods: before and after 2004.</p><p class="elsevierStylePara">As secondary objectives, we will describe basic characteristics of patients in both periods, associated comorbidity and technical characteristics of the treatment. We will also determine how these factors have influenced the results at the end of the follow-up period.</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">PATIENTS AND METHODS</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">This is a cohort study conducted in 1464 patients diagnosed with stage V chronic kidney disease and currently on PD technique in the Autonomous Community of Andalusia between 1 January 1999 and 31 December 2010. Children under the age of 14 have been excluded. </p><p class="elsevierStylePara">The cohort has been divided into two periods, before and after 1 January, 2004, the turning point was established by the introduction of more biocompatible solutions with bicarbonate and icodextrin. These comparative studies will be conducted between the two groups in terms of initial comorbidity, patient survival and technique survival.</p><p class="elsevierStylePara">All the information comes from Andalusia's Transplants Coordination Authority information system database (Andalusian Regional Ministry of Health). For the present study, we have collected various demographic variables, (such as sex and age at the start of technique treatment), aetiology of kidney disease, technique aspects, (such as automated PD (APD) or continuous ambulatory PD), type of solutions (lactate or bicarbonate with low glucose degradation products [GDP], icodextrin), implant technique and type of catheter, comorbidity at the beginning, Charlson index, average time spent in the technique, state at the end of follow-up (deceased, transplanted, transferred to HD or remains alive on technique) and cause of death if it occurred.</p><p class="elsevierStylePara">The statistical analysis was carried out using central tendency and dispersion measures (mean ± standard deviation) for quantitative variables, and frequencies for qualitative variables; for inferential statistics, the comparison of data using χ<span class="elsevierStyleSup">2</span> tests and Student's t-tests according to variable type, risk determination and 95% confidence intervals, survival curves and Kaplan-Meyer log-rank test for curve comparison. For the multivariate analysis, we used the Cox proportional hazards model.</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Patient characteristics</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The study has 1464 patients in PD (as of 31 December 2010 there were 352 patients in the programme). Mean age: 55±17 years, 40% of patients in their 60s, 70s and 80s. Sex: Male: 57%. Female: 43%. Mean permanence: 22±21 months. The most prevalent initial kidney diseases were diabetic nephropathy and glomerular pathology. Annual incidence rate is shown in Figure 1.</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Comparative data between both groups (incident patients before and after 2004)</span></span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">The baseline characteristics of patients </span>(Table 1) between the two groups are quite similar, with similar average age, similar percentages of patients older than 55 and 70 years, as well as almost identical percentages of diabetic patients. There were, however, significant differences in cardiovascular comorbidity, as reflected in the Charlson index difference. In the analysis of the Charlson categories, we note that there were no changes with respect to the groups of medium risk (Charlson index: 4-6), but there was a significant decrease of comorbid patients (Charlson index: ≥ 7) as well as an increase in patients with less comorbidity (Charlson index ≤ 3) on the second period studied.</p><p class="elsevierStylePara">The most prevalent aetiologies of initial kidney disease did not show significant differences between the two periods, diabetic nephropathy and glomerular diseases stand out as the most important ones, although they switch first and second position in each period.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Baseline technical aspects: </span>Table 2 presents the different PD techniques used among the groups. We must emphasize a more progressive use of APD since 51% of patients in the second period used this modality, with statistical difference when compared to the first period (34.5%). Similarly, more icodextrin solutions and solutions with bicarbonate and low GDP are used.</p><p class="elsevierStylePara">In recent years (second period) percutaneous techniques for the implementation of catheter have significantly increased, which may be interpreted as a greater autonomy of nephrology equipment for PD.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">We have carried out a comparative analysis by periods </span><span class="elsevierStyleBold">(Table</span><span class="elsevierStyleBold"> </span>3) <span class="elsevierStyleBold">of the three major causes of patient release from PD programme (death, transplant and transfer to HD). </span>For this purpose, we matched the follow-up time in both periods to 60 months. We observed that for the same time, the percentage of total releases in the period previous to 2004 is 87.5% at 5 years, higher than 61.2% outputs for incident patients after 2004. There is a declining trend of release by death (41.3% versus 27.6%), as well as an increase of release by transplant (30.6% versus 37.3%) and by transfer to HD (28.1% versus 35.1%). These differences are statistically significant.</p><p class="elsevierStylePara">The causes of death are similar in both periods, cardiovascular death being the most prominent.</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Analysis of patient’s survival</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The overall patient’s survival on PD technique in Andalusia in the period 1999-2010 had a median of 55 months and an average of 65 months (Figure 2).</p><p class="elsevierStylePara">The main risk factors for patient survival at the beginning of technique were: age, diabetes mellitus, cardiovascular disease, the type of PD technique (APD or CAPD) and the initial time of treatment (pre- or post- 2004), as shown in Figure 3.</p><p class="elsevierStylePara">When analysing the influence of the factors mentioned on survival, stratifying it by periods (before or after 2004), we observed that in all subgroups there was a better trend for survival in the second time period; reaching statistical significance in the subgroups of any type of technique, any age group and non-diabetic patients (Table 4).</p><p class="elsevierStylePara">We used Cox regression to assess the independence of the different risk factors and their influence on survival. The following factors were significant: (a) age (treated as a continuous variable), (b) cardiovascular disease, c) diabetes mellitus and d) being an incident patient during the first time period studied (prior to 2004) (Table 5).</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Influence of new solutions on patient survival</span></span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">In the studied population we have been able to show how significantly those patients treated with bicarbonate and low GDP and with icodextrin, at some point in their evolution showed better survival compared to those who used other types of solutions, as seen in Figure 4.</p><p class="elsevierStylePara">Until now we have seen that certain factors influence patient survival, such as diabetes, cardiovascular disease, age, type of PD technique, as well as the start period of technique. We just saw how the employment of new solutions also makes a difference in survival. But, are all these independent factors, or are they perhaps related? To answer this question we have built the following multivariate model (Table 6), where we observe that once solutions are introduced to the equation, the influence that time period held over survival loses significance.</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Analysis of technique survival</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The overall survival of patients on PD technique in Andalusia in the period 1999-2010 had a median of 68 months and an average of 73 months (Figure 5).</p><p class="elsevierStylePara">Among the factors that influence the most in the overall technique survival we find, again, the use of new bicarbonate and icodextrin solutions (Figure 6).</p><p class="elsevierStylePara">And as with the parallel analysis of patient survival, in the case of technique survival we also want to know which of these factors influence independently, through a multivariate Cox regression. The use of icodextrin and bicarbonate are shown as independent factors, as well as the start period of PD, which did not lose its statistical significance in this analysis (Table 7).</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara">In spite of the fact that therapeutic equivalence between PD and HD has been demonstrated, in Spain, and in recent years, we've seen only a minimal increase in the use of the first, carried on with variability among different communities and centres.<span class="elsevierStyleSup">10,11</span></p><p class="elsevierStylePara">However, for some time now, there are many publications that have demonstrated this therapeutic equivalence<span class="elsevierStyleSup">12</span> or even considered PD better than HD for certain groups of patients or in the initial period of renal replacement therapy.<span class="elsevierStyleSup">13-15</span></p><p class="elsevierStylePara">Along this line we proposed to study how the population treated with PD had behaved in Andalusia with respect to patient survival and technique during a long follow-up period of 12 years. As a response to the primary objective of our study and in light of the above results, we can state that PD within our environment has improved over time with respect to its results, both in patient survival and technique, during the most recent period.</p><p class="elsevierStylePara">There are several factors that influence this better prognosis. On patient survival, comorbid factors, such as diabetes, cardiovascular disease or age of the patient, have a great deal of influence at the beginning of the technique, but also, and in a very important way, the type of technique used (APD or CAPD) and the usage of the new solutions, more biocompatible and with less glucose concentration as osmotic agent. So much so, that the best results of the second period studied are clearly more conditioned by the increased use of these solutions over the last few years than by the time period itself, as other authors have reported.<span class="elsevierStyleSup">16,17</span></p><p class="elsevierStylePara">It seems that there are several points where the new solutions impact these results. When it comes to bicameral solutions with bicarbonate<span class="elsevierStyleSup">18</span>: in the first place, the suppression of GDP during manufacturing and storage of bags; secondly, the reduction of exposure to glucose, and, finally, the use of a more physiological buffer, such as bicarbonate. And as to the impact of solutions of icodextrin: on the one hand, through the reduction of exposure to glucose with this alternative osmotic agent. And on the other hand as a strategy for patients over hydrated due to insufficient peritoneal ultrafiltration, especially patients with hyperpermeable peritoneum indicated as temporary or permanent, or in long episodes (both in CAPD as in APD)<span class="elsevierStyleSup">19</span> .</p><p class="elsevierStylePara">Similarly, technique survival improved in the second period studied. This being an independent factor because in addition to the better protection of the peritoneal membrane due to the use of more biocompatible solutions (which proved to be independent factors as well), the technique experience accumulated, the better selection of PD patients in medical centres, more appropriate dialysis doses, better handling of the volume and more adequate treatment of complications such as peritonitis might have influenced the results.<span class="elsevierStyleSup">20, 21</span></p><p class="elsevierStylePara">We may finally conclude that PD, both within our environment and in general, has improved its performance in the last few years, unlike that of HD, which has remained stable.<span class="elsevierStyleSup">7</span>And that the new solutions play an important role in these better results, because they affect both in <span class="elsevierStyleBold">better technique prognosis</span>, probably <span class="elsevierStyleBold">through minimising</span> disruptions of the membrane and infections, as well as in a<span class="elsevierStyleBold"> better patient prognosis</span> through a proper balance of fluids for maintaining ultrafiltration and the reduction of systemic inflammatory effects.<span class="elsevierStyleSup">22</span> Since data for our study was collected from medical records, it is not possible to account for all prognostic factors that might have weight in the evaluation of risks, like factors of inflammation-malnutrition, etc. , and also in non-randomized populations there is always a residual adjustment not measured that may have limited the accuracy of results.</p><p class="elsevierStylePara">For all these reason, and in light of the current results, we can make our own assertion that the effectiveness of PD versus that of HD cannot be postulated as a discriminating feature. And that the low level of use of the first as renal substitute treatment in Spain, as well as in other countries, is conditioned by non-medical criteria, and therefore its use should be implemented through criteria of free choice, efficiency<span class="elsevierStyleSup">23</span> and development of PD units in nephrology departments.<span class="elsevierStyleSup">24</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The authors affirm that they have no conflicts of interest related to the contents of this article.</p><p class="elsevierStylePara"><a href="grande/11456_16025_35219_en_f111456_copy1.jpg" class="elsevierStyleCrossRefs"><img src="11456_16025_35219_en_f111456_copy1.jpg" alt="Incident patients in peritoneal dialysis per year"></img></a></p><p class="elsevierStylePara">Figure 1. Incident patients in peritoneal dialysis per year</p><p class="elsevierStylePara"><a href="grande/11456_16025_35220_en_f2114563.jpg" class="elsevierStyleCrossRefs"><img src="11456_16025_35220_en_f2114563.jpg" alt="Overall curve of patient survival, 1999-2010 period "></img></a></p><p class="elsevierStylePara">Figure 2. Overall curve of patient survival, 1999-2010 period </p><p class="elsevierStylePara"><a href="grande/11456_16025_35221_en_f3114565.jpg" class="elsevierStyleCrossRefs"><img src="11456_16025_35221_en_f3114565.jpg" alt="Influence of risk factors in patient survival (log-rank) "></img></a></p><p class="elsevierStylePara">Figure 3. Influence of risk factors in patient survival (log-rank) </p><p class="elsevierStylePara"><a href="grande/11456_16025_35222_en_f4114566.jpg" class="elsevierStyleCrossRefs"><img src="11456_16025_35222_en_f4114566.jpg" alt="Influence of new solutions (bicarbonate and icodextrine) on patient survival (log-rank)"></img></a></p><p class="elsevierStylePara">Figure 4. Influence of new solutions (bicarbonate and icodextrine) on patient survival (log-rank)</p><p class="elsevierStylePara"><a href="grande/11456_16025_35223_en_f51145611.jpg" class="elsevierStyleCrossRefs"><img src="11456_16025_35223_en_f51145611.jpg" alt="Overall technique&"></img></a></p><p class="elsevierStylePara">Figure 5. Overall technique&</p><p class="elsevierStylePara"><a href="grande/11456_16025_35224_en_f61145611.jpg" class="elsevierStyleCrossRefs"><img src="11456_16025_35224_en_f61145611.jpg" alt="Influence of new solutions on technique survival (log-rank)"></img></a></p><p class="elsevierStylePara">Figure 6. Influence of new solutions on technique survival (log-rank)</p><p class="elsevierStylePara"><a href="grande/11456_16025_35225_en_t111456.jpg" class="elsevierStyleCrossRefs"><img src="11456_16025_35225_en_t111456.jpg" alt="Baseline characteristics"></img></a></p><p class="elsevierStylePara">Table 1. Baseline characteristics</p><p class="elsevierStylePara"><a href="grande/11456_16025_35226_en_t211456.jpg" class="elsevierStyleCrossRefs"><img src="11456_16025_35226_en_t211456.jpg" alt="Technical aspects of peritoneal dialysis per time period "></img></a></p><p class="elsevierStylePara">Table 2. Technical aspects of peritoneal dialysis per time period </p><p class="elsevierStylePara"><a href="grande/11456_16025_35227_en_t3114566.jpg" class="elsevierStyleCrossRefs"><img src="11456_16025_35227_en_t3114566.jpg" alt="Causes of release from peritoneal dialysis technique and causes of death"></img></a></p><p class="elsevierStylePara">Table 3. Causes of release from peritoneal dialysis technique and causes of death</p><p class="elsevierStylePara"><a href="grande/11456_16025_35228_en_t4114564_copy1.jpg" class="elsevierStyleCrossRefs"><img src="11456_16025_35228_en_t4114564_copy1.jpg" alt="Survival rate stratified by risk factors and time period"></img></a></p><p class="elsevierStylePara">Table 4. Survival rate stratified by risk factors and time period</p><p class="elsevierStylePara"><a href="grande/11456_16025_35229_en_t5114564.jpg" class="elsevierStyleCrossRefs"><img src="11456_16025_35229_en_t5114564.jpg" alt="Multivariate study: Cox proportional hazards models"></img></a></p><p class="elsevierStylePara">Table 5. Multivariate study: Cox proportional hazards models</p><p class="elsevierStylePara"><a href="grande/11456_16025_35230_en_t6114566.jpg" class="elsevierStyleCrossRefs"><img src="11456_16025_35230_en_t6114566.jpg" alt="Multivariate study: Cox proportional hazard models"></img></a></p><p class="elsevierStylePara">Table 6. Multivariate study: Cox proportional hazard models</p><p class="elsevierStylePara"><a href="grande/11456_16025_35231_en_t7114564.jpg" class="elsevierStyleCrossRefs"><img src="11456_16025_35231_en_t7114564.jpg" alt="Technique&"></img></a></p><p class="elsevierStylePara">Table 7. Technique&</p>" "pdfFichero" => "P1-E543-S3677-A11456-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:4 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437478" "palabras" => array:1 [ 0 => "Soluciones de diálisis biocompatibles" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437482" "palabras" => array:1 [ 0 => "Supervivencia" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437485" "palabras" => array:1 [ 0 => "Resultados en salud" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437489" "palabras" => array:1 [ 0 => "Diálisis peritoneal" ] ] ] "en" => array:4 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437480" "palabras" => array:1 [ 0 => "Biocompatible dialysis fluids" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437483" "palabras" => array:1 [ 0 => "Survival" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437486" "palabras" => array:1 [ 0 => "Outcome" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437490" "palabras" => array:1 [ 0 => "Peritoneal dialysis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introducción:</span><span class="elsevierStyleBold"> </span>La supervivencia entre la hemodiálisis (HD) y la diálisis peritoneal (DP) son equivalentes, siendo los factores de comorbilidad asociados los que ejercen más influencia sobre la mortalidad. En los más recientes estudios, el pronóstico de la DP peritoneal ha mejorado proporcionalmente más que el de la HD, aunque esto no ha significado un aumento en la utilización de este tratamiento. <span class="elsevierStyleBold">Objetivos:</span> Conocer si la DP en nuestro medio ha mejorado en el tiempo con respecto a sus resultados. Conocer la influencia de la comorbilidad y las características del tratamiento en los resultados finales. <span class="elsevierStyleBold">Métodos:</span> Pacientes incidentes en DP en Andalucía entre 1999 y 2010. La cohorte se ha dividido en dos grupos: antes y después de 2004. Estadística: medias ± desviación estándar, frecuencias, test de χ<span class="elsevierStyleSup">2</span>, t de Student, determinación de riesgos (con intervalo de confianza al 95%), Kaplan-Meyer, <span class="elsevierStyleItalic">log-rank</span> y modelo multivariante de riesgo proporcional de Cox. <span class="elsevierStyleBold">Resultados:</span> 1464 pacientes incidentes en DP, 537 antes de 2004 y 927 posterior a 2004. Las características basales de ambos grupos (edad, diabetes) eran similares, si bien el primer grupo presentaba más enfermedad cardiovascular y comorbilidad medida por Charlson. En el segundo período se usó más DP automática y soluciones de bicarbonato e icodextrina. La supervivencia global de los pacientes fue 55 meses de mediana y 65 de media. En todos los subgrupos (edad, diabetes, enfermedad cardiovascular, tipo de técnica, diabetes) existe una mejor tendencia para la supervivencia en el segundo período (con significación para tipos de técnica, edad y diabéticos). Fueron factores independientes de riesgo la edad, la enfermedad cardiovascular, la diabetes mellitus y ser incidente antes de 2004. Esta última variable pierde significación cuando se incluyen las soluciones de bicarbonato e icodextrina, que sí se muestran como factores independientes de riesgo. La supervivencia de la técnica mostró una mediana de 68 meses y una media de 73 meses. Fueron factores independientes de riesgo para la técnica las soluciones de diálisis y el período de inicio de DP. <span class="elsevierStyleBold">Conclusiones:</span><span class="elsevierStyleBold"> </span>La DP ha mejorado sus resultados en los últimos años; probablemente las nuevas soluciones están influyendo positivamente. Por tanto, debería implementarse su uso a través de criterios de eficacia, libre elección, eficiencia, y desarrollarse plenamente las unidades de DP en los Servicios de Nefrología.</p>" ] "en" => array:1 [ "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction: </span>Survival rates between haemodialysis (HD) and peritoneal dialysis (PD) are the same but the associated comorbidity factors have a great impact on mortality. In the most recent studies the prognosis for PD has improved more than that for HD, although this has not meant an increase in the use of this treatment. <span class="elsevierStyleBold">Objectives:</span> To determine whether the PD has improved over time with respect to its outcomes in our community, and determine the influence of comorbidity and treatment characteristics on the final results. <span class="elsevierStyleBold">Methods:</span> Incident patients undergoing DP in Andalusia between 1999 and 2010. The cohort was divided into two groups: before and after 2004. Statistics: mean ± standard deviation, frequency, chi-square test, Student's t-test, risk determination (95% confidence interval), Kaplan-Meyer, log-rank and multivariate Cox proportional hazards models. <span class="elsevierStyleBold">Results:</span> 1464 incident patients undergoing DP, 537 before 2004 and 927 after 2004. The baseline characteristics of both groups (age, diabetes) were similar, although the first group had more severe cardiovascular disease and higher Charlson comorbidity index. In the second period, more automatic PD and solutions of bicarbonate and icodextrin were used. The overall survival rate for patients was 55 months median and 65 mean. Within all subgroups (age, diabetes, cardiovascular disease, technique type) there was a greater tendency towards survival in the second period (the technique type, age and diabetes were found to be statistically significant variables). Age, cardiovascular disease, diabetes mellitus and incident cases before 2004 were all independent risk factors. This latter variable lost significance as bicarbonate or icodextrin-based solutions were introduced, which were independent risk factors. Technique survival showed a median of 68 months and a mean of 73 months. Dialysis solutions and the period when the DP was initiated were independent risk factors for the technique. <span class="elsevierStyleBold">Conclusions: </span>DP has shown improved results in recent years; probably the new solutions are having a positive influence. As such PD should be implemented applying the criteria of effectiveness, free choice, efficiency and PD units should be fully developed within Nephrology Departments. </p> <p class="elsevierStylePara"> </p> <p class="elsevierStylePara"> </p> " ] ] "multimedia" => array:13 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11456_16025_35219_en_f111456_copy1.jpg" "Alto" => 880 "Ancho" => 1016 "Tamanyo" => 295139 ] ] "descripcion" => array:1 [ "en" => "Incident patients in peritoneal dialysis per year" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11456_16025_35220_en_f2114563.jpg" "Alto" => 881 "Ancho" => 1016 "Tamanyo" => 264907 ] ] "descripcion" => array:1 [ "en" => "Overall curve of patient survival, 1999-2010 period" ] ] 2 => array:8 [ "identificador" => "fig3" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11456_16025_35221_en_f3114565.jpg" "Alto" => 2655 "Ancho" => 2103 "Tamanyo" => 1065854 ] ] "descripcion" => array:1 [ "en" => "Influence of risk factors in patient survival (log-rank)" ] ] 3 => array:8 [ "identificador" => "fig4" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11456_16025_35222_en_f4114566.jpg" "Alto" => 843 "Ancho" => 2120 "Tamanyo" => 345380 ] ] "descripcion" => array:1 [ "en" => "Influence of new solutions (bicarbonate and icodextrine) on patient survival (log-rank)" ] ] 4 => array:8 [ "identificador" => "fig5" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11456_16025_35223_en_f51145611.jpg" "Alto" => 873 "Ancho" => 1020 "Tamanyo" => 219969 ] ] "descripcion" => array:1 [ "en" => "Overall technique&" ] ] 5 => array:8 [ "identificador" => "fig6" "etiqueta" => "Fig. 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11456_16025_35224_en_f61145611.jpg" "Alto" => 875 "Ancho" => 2107 "Tamanyo" => 370753 ] ] "descripcion" => array:1 [ "en" => "Influence of new solutions on technique survival (log-rank)" ] ] 6 => array:8 [ "identificador" => "fig7" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11456_16025_35225_en_t111456.jpg" "Alto" => 1117 "Ancho" => 2179 "Tamanyo" => 604517 ] ] "descripcion" => array:1 [ "en" => "Baseline characteristics" ] ] 7 => array:8 [ "identificador" => "fig8" "etiqueta" => "Tab. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11456_16025_35226_en_t211456.jpg" "Alto" => 676 "Ancho" => 2186 "Tamanyo" => 393244 ] ] "descripcion" => array:1 [ "en" => "Technical aspects of peritoneal dialysis per time period" ] ] 8 => array:8 [ "identificador" => "fig9" "etiqueta" => "Tab. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11456_16025_35227_en_t3114566.jpg" "Alto" => 954 "Ancho" => 2162 "Tamanyo" => 644764 ] ] "descripcion" => array:1 [ "en" => "Causes of release from peritoneal dialysis technique and causes of death" ] ] 9 => array:8 [ "identificador" => "fig10" "etiqueta" => "Tab. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11456_16025_35228_en_t4114564_copy1.jpg" "Alto" => 951 "Ancho" => 2173 "Tamanyo" => 655845 ] ] "descripcion" => array:1 [ "en" => "Survival rate stratified by risk factors and time period" ] ] 10 => array:8 [ "identificador" => "fig11" "etiqueta" => "Tab. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11456_16025_35229_en_t5114564.jpg" "Alto" => 400 "Ancho" => 2164 "Tamanyo" => 320664 ] ] "descripcion" => array:1 [ "en" => "Multivariate study: Cox proportional hazards models" ] ] 11 => array:8 [ "identificador" => "fig12" "etiqueta" => "Tab. 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11456_16025_35230_en_t6114566.jpg" "Alto" => 457 "Ancho" => 2158 "Tamanyo" => 429463 ] ] "descripcion" => array:1 [ "en" => "Multivariate study: Cox proportional hazard models" ] ] 12 => array:8 [ "identificador" => "fig13" "etiqueta" => "Tab. 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11456_16025_35231_en_t7114564.jpg" "Alto" => 273 "Ancho" => 2157 "Tamanyo" => 249365 ] ] "descripcion" => array:1 [ "en" => "Technique&" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:24 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Xue JL, Everson SE, Constantini EG, Ebben JP,\u{A0}Chen SC,\u{A0}Agodoa LY,\u{A0}et al. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 5 | 8 |
| 2024 October | 60 | 31 | 91 |
| 2024 September | 69 | 33 | 102 |
| 2024 August | 81 | 66 | 147 |
| 2024 July | 58 | 371 | 429 |
| 2024 June | 86 | 48 | 134 |
| 2024 May | 86 | 32 | 118 |
| 2024 April | 66 | 47 | 113 |
| 2024 March | 60 | 25 | 85 |
| 2024 February | 57 | 38 | 95 |
| 2024 January | 34 | 25 | 59 |
| 2023 December | 50 | 25 | 75 |
| 2023 November | 72 | 42 | 114 |
| 2023 October | 98 | 32 | 130 |
| 2023 September | 70 | 40 | 110 |
| 2023 August | 58 | 22 | 80 |
| 2023 July | 68 | 714 | 782 |
| 2023 June | 90 | 21 | 111 |
| 2023 May | 62 | 35 | 97 |
| 2023 April | 61 | 20 | 81 |
| 2023 March | 68 | 22 | 90 |
| 2023 February | 45 | 21 | 66 |
| 2023 January | 59 | 16 | 75 |
| 2022 December | 60 | 24 | 84 |
| 2022 November | 57 | 42 | 99 |
| 2022 October | 59 | 47 | 106 |
| 2022 September | 43 | 26 | 69 |
| 2022 August | 60 | 51 | 111 |
| 2022 July | 42 | 47 | 89 |
| 2022 June | 52 | 47 | 99 |
| 2022 May | 31 | 38 | 69 |
| 2022 April | 40 | 44 | 84 |
| 2022 March | 39 | 43 | 82 |
| 2022 February | 32 | 42 | 74 |
| 2022 January | 40 | 34 | 74 |
| 2021 December | 43 | 41 | 84 |
| 2021 November | 39 | 33 | 72 |
| 2021 October | 43 | 35 | 78 |
| 2021 September | 25 | 27 | 52 |
| 2021 August | 47 | 39 | 86 |
| 2021 July | 57 | 28 | 85 |
| 2021 June | 38 | 20 | 58 |
| 2021 May | 61 | 30 | 91 |
| 2021 April | 87 | 61 | 148 |
| 2021 March | 46 | 34 | 80 |
| 2021 February | 38 | 16 | 54 |
| 2021 January | 43 | 14 | 57 |
| 2020 December | 26 | 12 | 38 |
| 2020 November | 26 | 21 | 47 |
| 2020 October | 42 | 22 | 64 |
| 2020 September | 49 | 7 | 56 |
| 2020 August | 43 | 8 | 51 |
| 2020 July | 53 | 8 | 61 |
| 2020 June | 51 | 10 | 61 |
| 2020 May | 59 | 10 | 69 |
| 2020 April | 57 | 16 | 73 |
| 2020 March | 53 | 18 | 71 |
| 2020 February | 58 | 14 | 72 |
| 2020 January | 64 | 19 | 83 |
| 2019 December | 65 | 24 | 89 |
| 2019 November | 53 | 17 | 70 |
| 2019 October | 60 | 5 | 65 |
| 2019 September | 71 | 19 | 90 |
| 2019 August | 43 | 11 | 54 |
| 2019 July | 68 | 28 | 96 |
| 2019 June | 75 | 22 | 97 |
| 2019 May | 64 | 22 | 86 |
| 2019 April | 132 | 42 | 174 |
| 2019 March | 91 | 20 | 111 |
| 2019 February | 44 | 16 | 60 |
| 2019 January | 46 | 21 | 67 |
| 2018 December | 87 | 36 | 123 |
| 2018 November | 104 | 9 | 113 |
| 2018 October | 121 | 19 | 140 |
| 2018 September | 84 | 12 | 96 |
| 2018 August | 62 | 15 | 77 |
| 2018 July | 70 | 20 | 90 |
| 2018 June | 46 | 7 | 53 |
| 2018 May | 55 | 19 | 74 |
| 2018 April | 61 | 9 | 70 |
| 2018 March | 58 | 8 | 66 |
| 2018 February | 48 | 10 | 58 |
| 2018 January | 48 | 12 | 60 |
| 2017 December | 50 | 12 | 62 |
| 2017 November | 61 | 10 | 71 |
| 2017 October | 37 | 7 | 44 |
| 2017 September | 44 | 12 | 56 |
| 2017 August | 37 | 7 | 44 |
| 2017 July | 29 | 9 | 38 |
| 2017 June | 41 | 6 | 47 |
| 2017 May | 47 | 11 | 58 |
| 2017 April | 49 | 11 | 60 |
| 2017 March | 32 | 15 | 47 |
| 2017 February | 70 | 10 | 80 |
| 2017 January | 39 | 7 | 46 |
| 2016 December | 75 | 6 | 81 |
| 2016 November | 113 | 22 | 135 |
| 2016 October | 148 | 7 | 155 |
| 2016 September | 197 | 7 | 204 |
| 2016 August | 251 | 11 | 262 |
| 2016 July | 197 | 13 | 210 |
| 2016 June | 172 | 0 | 172 |
| 2016 May | 183 | 0 | 183 |
| 2016 April | 140 | 0 | 140 |
| 2016 March | 150 | 0 | 150 |
| 2016 February | 162 | 0 | 162 |
| 2016 January | 152 | 0 | 152 |
| 2015 December | 170 | 0 | 170 |
| 2015 November | 132 | 0 | 132 |
| 2015 October | 120 | 0 | 120 |
| 2015 September | 99 | 0 | 99 |
| 2015 August | 89 | 0 | 89 |
| 2015 July | 82 | 0 | 82 |
| 2015 June | 43 | 0 | 43 |
| 2015 May | 39 | 0 | 39 |
| 2015 April | 5 | 0 | 5 |
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