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Rizzolo K, Cervantes L, Wilhalme H, Vasilyev A, Shen JI. Differences in Outcomes by Place of Origin among Hispanic Patients with Kidney Failure. J Am Soc Nephrol 2023; 34:2013-2023. [PMID: 37755821 PMCID: PMC10703086 DOI: 10.1681/asn.0000000000000239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
SIGNIFICANCE STATEMENT Hispanic patients are known to have a higher risk of kidney failure and lower rates of home dialysis use and kidney transplantation than non-Hispanic White patients. However, it is unknown whether these outcomes differ within the Hispanic community, which is heterogeneous in its members' places of origins. Using United States Renal Data System data, the authors found similar adjusted rates of home dialysis use for patients originating from places outside the United States and US-born Hispanic patients, whereas the adjusted risk of mortality and likelihood of transplantation differed depending on place (country or territory) of origin. Understanding the heterogeneity in kidney disease outcomes and treatment within the Hispanic community is crucial in designing interventions and implementation strategies to ensure that Hispanic individuals with kidney failure have equitable access to care. BACKGROUND Compared with non-Hispanic White groups, Hispanic individuals have a higher risk of kidney failure yet lower rates of living donor transplantation and home dialysis. However, how home dialysis, mortality, and transplantation vary within the Hispanic community depending on patients' place of origin is unclear. METHODS We identified adult Hispanic patients from the United States Renal Data System who initiated dialysis in 2009-2017. Primary exposure was country or territory of origin (the United States, Mexico, US-Puerto Rico, and other countries). We used logistic regression to estimate differences in odds of initiating home dialysis and competing risk models to estimate subdistribution hazard ratios (SHR) of mortality and kidney transplantation. RESULTS Of 137,039 patients, 44.4% were US-born, 30.9% were from Mexico, 12.9% were from US-Puerto Rico, and 11.8% were from other countries. Home dialysis rates were higher among US-born patients, but not significantly different after adjusting for demographic, medical, socioeconomic, and facility-level factors. Adjusted mortality risk was higher for individuals from US-Puerto Rico (SHR, 1.04; 95% confidence interval [CI], 1.01 to 1.08) and lower for Mexico (SHR, 0.80; 95% CI, 0.78 to 0.81) and other countries (SHR, 0.83; 95% CI, 0.81 to 0.86) compared with US-born patients. The adjusted rate of transplantation for Mexican or US-Puerto Rican patients was similar to that of US-born patients but higher for those from other countries (SHR, 1.22; 95% CI, 1.15 to 1.30). CONCLUSIONS Hispanic people from different places of origin have similar adjusted rates of home dialysis but different adjusted rates of mortality and kidney transplantation. Further research is needed to understand the mechanisms underlying these observed differences in outcomes.
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Affiliation(s)
- Katherine Rizzolo
- Section of Nephrology, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Lilia Cervantes
- Department of Medicine, University of Colorado Anschutz Campus, Denver, Colorado
| | - Holly Wilhalme
- David Geffen School of Medicine at University of California, Los Angeles, California, Los Angeles, California
| | - Arseniy Vasilyev
- David Geffen School of Medicine at University of California, Los Angeles, California, Los Angeles, California
| | - Jenny I. Shen
- David Geffen School of Medicine at University of California, Los Angeles, California, Los Angeles, California
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
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Gadola L, Orihuela L, Pérez D, Gómez T, Solá L, Chifflet L, Mautone M, Torres E, Rodriguez G. Peritonitis in Peritoneal Dialysis Patients in Uruguay. Perit Dial Int 2020. [DOI: 10.1177/089686080802800307] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Uruguay is a South American country (3241003 inhabitants) where renal replacement treatment is universally available. The aim of this study was to analyze the incidence and outcome of peritonitis, and the causative organisms and their sensitivity, in order to recommend an empiric initial antibiotic treatment. A retrospective descriptive study of all peritonitis during the period 2004 – 2005 was performed (144 peritonitis, 44% due to gram-positive bacteria). We conclude that the high prevalence of methicillin-resistant coagulase-negative staphylococci justifies the use of vancomycin in the national empiric initial antibiotic protocols.
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Affiliation(s)
- Liliana Gadola
- Department of Nephrology: Hospital de Clínicas, Montevideo, Uruguay
- CASMU, Montevideo, Uruguay
| | - Lucía Orihuela
- Department of Nephrology: Hospital de Clínicas, Montevideo, Uruguay
| | | | | | | | - Liliana Chifflet
- Department of Nephrology: Hospital de Clínicas, Montevideo, Uruguay
| | | | - Eugenia Torres
- Department of Nephrology: Hospital de Clínicas, Montevideo, Uruguay
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Socioeconomic status and mortality among dialysis patients: a systematic review and meta-analysis. Int Urol Nephrol 2019; 51:509-518. [PMID: 30689180 DOI: 10.1007/s11255-019-02078-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 01/03/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND The reported association between individual indicators of socioeconomic status (SES) and mortality in dialysis patients was inconsistent in previous studies. We performed a meta-analysis to identify the association between SES and mortality of dialysis population. METHODS The meta-analysis was conducted in accordance with MOOSE guidelines. Cohorts evaluating the association between SES indicators (income, education and occupation) and mortality in dialysis patients were included. Random-effects models were used to pool the adjusted relative risk (RR) from individual studies. Heterogeneity was assessed by Cochrane's Q and the I2 statistic. Subgroup analyses and sensitivity analyses were performed to identify sources of heterogeneity and to evaluate the robustness of findings. RESULTS Fourteen studies were finally included. In hemodialysis patients, increased mortality was associated with lower level of income (RR = 1.08, 95%CI [1.01-1.16], P = 0.035; I2 = 87.9%, P < 0.001) and occupation (RR = 1.63, 95%CI [1.11-2.38], P = 0.013; I2 = 0.0%, P = 0.601). However, no significant association was identified for education (RR = 1.43, 95%CI [0.92-2.25]; P = 0.112; I2 = 68.3%,P = 0.001). In patients receiving peritoneal dialysis, lower level of income (RR = 1.80, 95%CI [1.12-2.88],P = 0.015; I2 = 75.9%, P = 0.042), education (RR = 1.27, 95%CI [1.13-1.43], P < 0.001; I2 = 0.0%, P = 0.684), and occupation (RR = 3.42, 95% CI [1.35-8.70], P = 0.010) were risk factors for increased mortality. Subgroup analysis showed the association between SES indicators and mortality in hemodialysis differed according to geographic locations and study designs. CONCLUSION Lower SES (measured by income, education, and occupation) tends to be associated with higher mortality in patients receiving maintenance dialysis. But the magnitude of the associations varied for different individual indicators of SES.
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de Oliveira MP, Kusumota L, Haas VJ, Ribeiro RDCHM, Marques S, Oller GASADO. Health-related quality of life as a predictor of mortality in patients on peritoneal dialysis. Rev Lat Am Enfermagem 2016; 24:e2687. [PMID: 27192413 PMCID: PMC4862750 DOI: 10.1590/1518-8345.0786.2687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 05/17/2015] [Indexed: 12/16/2022] Open
Abstract
Objective: to characterize deaths that occurred, and the association between
socio-demographic, clinical, laboratory variables and health-related quality of
life and the outcome of death in patients on peritoneal dialysis, over a two year
period after an initial assessment. Method: observational, prospective population study with 82 patients on peritoneal
dialysis. The instruments used for the first stage of data collection were the
mini-mental state examination, a sociodemographic, economic, clinical and
laboratory questionnaire and the Kidney Disease and Quality of Life-Short Form.
After two years, data for characterization and occurrence of death in the period
were collected. The relative risk of death outcome was calculated through
statistical analysis; the risk of death was estimated by the survival Kaplan-Meier
curve, and determined predictors of death by the Cox Proportional Hazards Model.
Results: of the 82 original participants, 23 had as an outcome death within two years. The
increased risk for the outcome of death was associated with a lower mean score of
health-related quality of life in the physical functioning domain. Conclusion: the worst health-related quality of life in the physical functioning domain, could
be considered a predictor of death.
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Affiliation(s)
| | - Luciana Kusumota
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Vanderlei José Haas
- Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | | | - Sueli Marques
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Abstract
Background. There is strong evidence from a range of long-term conditions of improved outcomes where patients are involved in self-management. Against this background, the international trend for home dialysis continues to decline, with centre-based haemodialysis continuing its dominance. Methods. An opinion-based commentary exploring practice patterns and drivers for home dialysis internationally. Data are drawn from a number of sources including the 2010 United States Renal Data System report. Results. Drivers behind the use of home dialysis are complex including factors relating to the patient and their carers, health care team, health care system, geography and cultural factors. There are important examples where local champions or public health initiatives have had a positive impact on the use of home dialysis; however, in many settings significant barriers remain. Better systems for giving patient information, shared decision making and involving patients in their own care may have the potential to act as a driver for change. Conclusion. Centre-based haemodialysis continues to dominate renal replacement therapy internationally with notable exceptions. Such dominance suggests that most patients worldwide do not get much choice when it comes to modality selection.
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Affiliation(s)
- Martin Wilkie
- Sheffield Kidney Institute Sheffield Teaching Hospitals NHS, Sheffield, UK
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Sanabria M, Devia M, Hernández G, Astudillo K, Trillos C, Uribe M, Latorre C, Bernal A, Rivera A. Outcomes of a peritoneal dialysis program in remote communities within Colombia. Perit Dial Int 2014; 35:52-61. [PMID: 24497583 DOI: 10.3747/pdi.2012.00301] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Colombia is a country of diverse geographic regions, some with mountainous terrain that can make access to urban areas difficult for individuals who live in remote areas. In 2005, a program was initiated to establish remote peritoneal dialysis (PD) centers in Colombia to improve access to PD for patients with end-stage renal disease who face geographic or financial access barriers. PATIENTS AND METHODS The present study was a multi-center cohort observational study of prevalent home PD patients who were at least 18 years of age and were being managed by one of nine established remote PD centers in Colombia over a 2-year period. Data were collected from clinical records, databases, and patient interviews. Patient survival, incidence of peritonitis, and rate of withdrawal from PD therapy were assessed. RESULTS A total of 345 patients were eligible for the study. The majority (87.8%) of patients lived on one to two times a minimum monthly salary (equivalent to US$243 - US$486). On average, patients traveled 1.2 hours and 4.3 hours from their home to their remote PD center or an urban reference renal clinic, respectively. The incidence rate of peritonitis was 2.54 episodes per 100 patient-months of therapy. A bivariate analysis showed a significantly higher risk of peritonitis in patients who were living on less than one times a monthly minimum salary (p < 0.05) or who had a dirt, cement, or unfinished wood floor (p < 0.05). The 1-year and 2-year patient survival rates were 92.44% and 81.55%, respectively. The 1-year and 2-year technique survival rates were 97.27% and 89.78%, respectively. CONCLUSIONS With the support of remote PD centers that mitigate geographic and financial barriers to healthcare, home PD therapy is a safe and appropriate treatment option for patients who live in remote areas in Colombia.
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Affiliation(s)
- Mauricio Sanabria
- Baxter RTS Colombia, Bogotá, Colombia; Universidad del Rosario, Bogotá, Colombia; and Baxter Latin America, Bogotá, Colombia
| | - Martha Devia
- Baxter RTS Colombia, Bogotá, Colombia; Universidad del Rosario, Bogotá, Colombia; and Baxter Latin America, Bogotá, Colombia
| | - Gilma Hernández
- Baxter RTS Colombia, Bogotá, Colombia; Universidad del Rosario, Bogotá, Colombia; and Baxter Latin America, Bogotá, Colombia
| | - Kindar Astudillo
- Baxter RTS Colombia, Bogotá, Colombia; Universidad del Rosario, Bogotá, Colombia; and Baxter Latin America, Bogotá, Colombia
| | - Carlos Trillos
- Baxter RTS Colombia, Bogotá, Colombia; Universidad del Rosario, Bogotá, Colombia; and Baxter Latin America, Bogotá, Colombia
| | - Mauricio Uribe
- Baxter RTS Colombia, Bogotá, Colombia; Universidad del Rosario, Bogotá, Colombia; and Baxter Latin America, Bogotá, Colombia
| | - Catalina Latorre
- Baxter RTS Colombia, Bogotá, Colombia; Universidad del Rosario, Bogotá, Colombia; and Baxter Latin America, Bogotá, Colombia
| | - Astrid Bernal
- Baxter RTS Colombia, Bogotá, Colombia; Universidad del Rosario, Bogotá, Colombia; and Baxter Latin America, Bogotá, Colombia
| | - Angela Rivera
- Baxter RTS Colombia, Bogotá, Colombia; Universidad del Rosario, Bogotá, Colombia; and Baxter Latin America, Bogotá, Colombia
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The gap between estimated incidence of end-stage renal disease and use of therapy. PLoS One 2013; 8:e72860. [PMID: 24023651 PMCID: PMC3758352 DOI: 10.1371/journal.pone.0072860] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 07/13/2013] [Indexed: 11/30/2022] Open
Abstract
Background Relatively few data exist on the burden of end-stage renal disease (ESRD) and use of renal replacement therapy (RRT)–a life-saving therapy–in developing regions. No study has quantified the proportion of patients who develop ESRD but are unable to access RRT. Methods We performed a comprehensive literature search to estimate use and annual initiation of RRT worldwide, and present these estimates according to World Bank regions. We also present estimates of survival and of etiology of diseases in patients undergoing RRT. Using data on prevalence of diabetes and hypertension, we modeled the incidence of ESRD related to these risk factors in order to quantify the gap between ESRD and use of RRT in developing regions. Results We find that 1.9 million patients are undergoing RRT worldwide, with continued use and annual initiation at 316 and 73 per million population respectively. RRT use correlates directly (Pearson’s r = 0.94) with regional income. Hemodialysis remains the dominant form of RRT but there is wide regional variation in its use. With the exception of the Latin American and Caribbean region, it appears that initiation of RRT in developing regions is restricted to fewer than a quarter of patients projected to develop ESRD. This results in at least 1.2 million premature deaths each year due to lack of access to RRT as a result of diabetes and elevated blood pressure and as many as 3.2 million premature deaths due to all causes of ESRD. Conclusion Thus, the majority of patients projected to reach ESRD due to diabetes or hypertension in developing regions are unable to access RRT; this gap will increase with rising prevalence of these risk factors worldwide.
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de Andrade Bastos K, Qureshi AR, Lopes AA, Fernandes N, Barbosa LMM, Pecoits-Filho R, Divino-Filho JC. Family Income and Survival in Brazilian Peritoneal Dialysis Multicenter Study Patients (BRAZPD): Time to Revisit a Myth? Clin J Am Soc Nephrol 2011; 6:1676-83. [DOI: 10.2215/cjn.09041010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lobo J, Schargorodsky J, Quiroga MA, Hendel I, Vallvé C, Barone R. Peritoneal Dialysis in Argentina. A Nationwide Study. Perit Dial Int 2011; 31:19-26. [DOI: 10.3747/pdi.2009.00187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jorge Lobo
- Asociación Nefrológica Buenos Aires, Consejo de Diálisis Peritoneal, Buenos Aires, Argentina
| | - Jorge Schargorodsky
- Asociación Nefrológica Buenos Aires, Consejo de Diálisis Peritoneal, Buenos Aires, Argentina
| | - Mabel Alvarez Quiroga
- Asociación Nefrológica Buenos Aires, Consejo de Diálisis Peritoneal, Buenos Aires, Argentina
| | - Irene Hendel
- Asociación Nefrológica Buenos Aires, Consejo de Diálisis Peritoneal, Buenos Aires, Argentina
| | - Cristina Vallvé
- Asociación Nefrológica Buenos Aires, Consejo de Diálisis Peritoneal, Buenos Aires, Argentina
| | - Roberto Barone
- Asociación Nefrológica Buenos Aires, Consejo de Diálisis Peritoneal, Buenos Aires, Argentina
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Moraes TP, Pecoits–Filho R, Ribeiro SC, Rigo M, Silva MM, Teixeira PS, Pasqual DD, Fuerbringer R, Riella MC. Peritoneal Dialysis in Brazil: Twenty-Five Years of Experience in a Single Center. Perit Dial Int 2009. [DOI: 10.1177/089686080902900503] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives To evaluate patient and technique survival and to provide an analysis of peritoneal dialysis (PD)-related peritonitis in 25 years of experience in a single center. Study Design Retrospective study of incident patients on PD from July 1980 to July 2005. Setting Single, university based, Brazilian dialysis program. Patients 680 patients were analyzed in our study from July 1980 to July 2005, with a cumulative experience of 15303 patient-months. All patients over 15 years of age entering the dialysis program were included in the study. Patients with less than 30 days of follow-up were excluded. Biochemical and demographic variables, peritonitis episodes, and patient and technique survival were analyzed. Results Mean age at start of PD was 53 ± 16 years; diabetic nephropathy was the main cause of chronic kidney disease. Cardiovascular disease was the main cause of death (44%); peritonitis was responsible for 16% of fatal events. The predictors of death in our study were diabetes [relative risk (RR) 1.23, p < 0.01], advanced age (RR 1.58, p < 0.001), low serum albumin level (RR 1.25, p < 0.01), and low serum phosphate level (RR 1.39, p < 0.001) upon starting PD. There were 1048 cases of peritonitis over the 25-year period, with a significant reduction in incidence after the introduction of the double-bag system. The number of incident PD patients originating from hemodialysis increased threefold over the observation period ( p < 0.001), with a similar increase in comorbidities over time. Conclusion In the largest single-center report of PD experience in Latin America, we describe the overall rate and trends over time of peritonitis as well as patient and technique survival, which are similar to previous reports. Significant changes in peritonitis rates and causative organisms as well as a significant time-dependent increase in high-risk patients starting PD were observed.
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Affiliation(s)
| | - Roberto Pecoits–Filho
- Pro-Renal Kidney Foundation, Curitiba, Brazil
- Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | | | - Mariane Rigo
- Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Margarete M. Silva
- Pro-Renal Kidney Foundation, Curitiba, Brazil
- Nephrology Division, Hospital Universitário Evangélico de Curitiba, Curitiba, Brazil
| | | | | | | | - Miguel C. Riella
- Pro-Renal Kidney Foundation, Curitiba, Brazil
- Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
- Nephrology Division, Hospital Universitário Evangélico de Curitiba, Curitiba, Brazil
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Fernandes N, Bastos MG, Cassi HV, Machado NL, Ribeiro JA, Martins G, Mourão O, Bastos K, Ferreira Filho SR, Lemos VM, Abdo M, Vannuchi MTI, Mocelin A, Bettoni SL, Valenzuela RV, Lima MM, Pinto SW, Riella MC, Qureshi AR, Divino Filho JC, Pecoits-Filho R. The Brazilian Peritoneal Dialysis Multicenter Study (BRAZPD) : characterization of the cohort. Kidney Int 2008:S145-51. [PMID: 18379538 DOI: 10.1038/sj.ki.5002616] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Brazilian Peritoneal Dialysis Multicenter Study (BRAZPD) was launched in December 2004 aiming to collect data monthly and continuously from a representative cohort, allowing for a continuous snapshot of the peritoneal dialysis (PD) reality in the country. This is an observational study of PD patients comprising follow-up from December 2004 to February 2007 (mean follow-up of 13.6 months-ranging from 1 to 26 months) in 114 Brazilian centers. All centers report data through a central web-based database. After an initial baseline retrospective data collection, all patients are followed prospectively every month until they drop out from the PD program. Total number of patients recruited until February 2007 was 3226 (2094 incident patients). Mean age was 54+/-19 years (37% above 65 years old), with 55% females and 64% Caucasians. The more frequent causes of renal failure were diabetic nephropathy (34%), renal vascular disease associated with hypertension (26%), and glomerulopathies (13%). The most common comorbidities were hypertension (76%), diabetes (36%), and ischemic heart disease (23%). Automated PD (APD) was the modality utilized in 53%. The estimated overall peritonitis rate was 1 episode per 30 patient-months (most frequently due to Staphylococcus aureus). The total dropout rate was 33%, mainly due to deaths, whereas 20% of dropouts were due to renal transplant. The gross mortality was 17.6% and the main causes of mortality were cardiovascular diseases (40%) and infections (15%). The initial results of this first Brazilian PD registry provide a unique opportunity to develop future clinical studies addressing specific PD questions in the Brazilian reality and context.
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Affiliation(s)
- N Fernandes
- NIEPEN da Fundação IMEPEN e Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
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