The analysis of outcomes and dropout causes in peritoneal dialysis patients in a medical center

Objective To discuss the countermeasures for the peritoneal dialysis (PD) drop-out by analyzing the reason for the patients who have withdrawn from PD. Methods The clinical data of patients at our hospital who started with PD because of chronic renal failure from August 2005 to March 2018 were collected，and the proportions and reasons for dropouts were analyzed. Results A total of 299 patients were recruited in this study. Among them, 143 cases were transferred out of the follow-up system of PD. In detail, 69 cases (48.3%) were transferred to other hospitals for regional or medical reasons, 30 cases (21.0%) were switched to hemodialysis (HD), 16 cases (11.2%) underwent kidney transplantation, and 28 cases (19.6%) died. The first cause of death was cardiovascular and cerebrovascular events (12 cases, 42.9%)，followed by malnutrition (6 cases, 21.4%), infection (5 cases, 17.9%) and tumor factors (5 cases, 17.9%). Higher levels of TC, LDL,DBP and lower levels of total kt/v were found in patients switcher to HD, while higher levels of CRP and PTH, as well as lower levels of residual renal kt/v and total kt/v, were found in patients who switched to HD compared with patients still undergoing PD. Moreover, in death group, patients had significant lower levels of Alb, PTH, DBP, Scr, residual renal Kt/v and total Kt/v, and higher levels of TC, TG and LDL (all P＜0.05). Logistic analysis showed that residual renal Kt/v was inversely correlated with possibility for patients switching to HD (P＜0.05). Cox analysis showed that advanced strating age of PD, high levels of serum CRP, calcium and phosphorus, and low levels of Scr and residual kidney Kt/v were risk factors for mortality in PD patients. Conclusion changing from PD to hemodialysis is the most common cause of dropout in PD patients,followed by death. Peritonitis is the main cause in patients change to HD.cardiac-cerebral vascular is the major cause for death, followed by malnutrition.the lese residual renal Kt/v at the time of catheterization, the easier it is to transfer hemodialysis. Therefore, timely dialysis, standard operation, improvement of nutrition, and control of cardiovascular risk factors are measures to improve the long-term survival of peritoneal dialysis patients.