Masashi Mizuno1,2, Yasuhiko Ito3,4, Yasuhiro Suzuki3,4, Fumiko Sakata3,4, Yosuke Saka5,6, Takeyuki Hiramatsu7, Hirofumi Tamai8, Makoto Mizutani9, Tomohiko Naruse6, Norimi Ohashi10, Hirotake Kasuga11, Hideaki Shimizu12, Hisashi Kurata13, Kei Kurata14, Satoshi Suzuki15, Satoko Kido16, Yoshikazu Tsuruta16, Teppei Matsuoka17, Masanobu Horie18, Shoichi Maruyama4, Seiichi Matsuo4. 1. Division of Nephrology, Renal Replacement Therapy, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. masashim1jp@yahoo.co.jp. 2. Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan. masashim1jp@yahoo.co.jp. 3. Division of Nephrology, Renal Replacement Therapy, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. 4. Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan. 5. Yokkaichi Municipal Hospital, Yokkaichi, Japan. 6. Kasugai Municipal Hospital, Kasugai, Japan. 7. Konan Kosei Hospital, Konan, Japan. 8. Anjo Kosei Hospital, Anjo, Japan. 9. Handa City Hospital, Handa, Japan. 10. Ogaki Municipal Hospital, Ogaki, Japan. 11. Nagoya Kyoritsu Hospital, Nagoya, Japan. 12. Chubu Rosai Hospital, Nagoya, Japan. 13. Toyota Kosei Hospital, Yoyota, Japan. 14. Tosei General Hospital, Seto, Japan. 15. Kainan Hospital, Yatomi, Japan. 16. Minami Seikyo Hospital, Nagoya, Japan. 17. Ogaki Kita Clinic, Ogaki, Japan. 18. Daiyukai Daiichi Hospital, Ichinomiya, Japan.
Abstract
BACKGROUND: Early withdrawal within 3 years after starting peritoneal dialysis (PD) and PD-related peritonitis have been major obstacles preventing increases in the population of PD patients. To address these problems, we implemented education programs for medical staff. This study analyzed the recent status and outcomes of PD therapy, focusing on findings such as the incidence and prognosis of peritonitis as of 5 years after our last study. METHODS: We investigated background, laboratory data and status of PD therapy, reasons for withdrawal from PD and incidental statements on peritonitis from 2010 to 2012 (R2), and compared findings with those from our last study of 2005-2007 (R1). RESULTS: Early PD therapy withdrawal in R2 clearly improved to 44.7 %, compared with 50.9 % in R1. Peritonitis incidence improved slightly from once per 42.8 months/patient in R1 to once per 47.3 months/patient in R2. Notably, PD-related peritonitis as a cause of mortality improved markedly in R2, but outcomes of PD-related peritonitis did not change significantly between R1 and R2. In contrast, social problems increased as a reason for withdrawal from PD therapy. CONCLUSION: Our efforts at education might have been useful for improving early withdrawal from PD and deaths attributable to PD-related peritonitis. However, since improvements to incidence of PD-related peritonitis were limited by education, further improvement in PD-related peritonitis incidence requires development of new sterilized connecting systems during PD-bag exchanges to decrease PD-related peritonitis opportunities. Construction of medical support systems to address social problems is required to maintain long-term PD therapy.
BACKGROUND: Early withdrawal within 3 years after starting peritoneal dialysis (PD) and PD-related peritonitis have been major obstacles preventing increases in the population of PD patients. To address these problems, we implemented education programs for medical staff. This study analyzed the recent status and outcomes of PD therapy, focusing on findings such as the incidence and prognosis of peritonitis as of 5 years after our last study. METHODS: We investigated background, laboratory data and status of PD therapy, reasons for withdrawal from PD and incidental statements on peritonitis from 2010 to 2012 (R2), and compared findings with those from our last study of 2005-2007 (R1). RESULTS: Early PD therapy withdrawal in R2 clearly improved to 44.7 %, compared with 50.9 % in R1. Peritonitis incidence improved slightly from once per 42.8 months/patient in R1 to once per 47.3 months/patient in R2. Notably, PD-related peritonitis as a cause of mortality improved markedly in R2, but outcomes of PD-related peritonitis did not change significantly between R1 and R2. In contrast, social problems increased as a reason for withdrawal from PD therapy. CONCLUSION: Our efforts at education might have been useful for improving early withdrawal from PD and deaths attributable to PD-related peritonitis. However, since improvements to incidence of PD-related peritonitis were limited by education, further improvement in PD-related peritonitis incidence requires development of new sterilized connecting systems during PD-bag exchanges to decrease PD-related peritonitis opportunities. Construction of medical support systems to address social problems is required to maintain long-term PD therapy.
Entities:
Keywords:
Early withdrawal; Education; Peritoneal dialysis; Peritonitis
Authors: Philip Kam-Tao Li; Cheuk Chun Szeto; Beth Piraino; Judith Bernardini; Ana E Figueiredo; Amit Gupta; David W Johnson; Ed J Kuijper; Wai-Choong Lye; William Salzer; Franz Schaefer; Dirk G Struijk Journal: Perit Dial Int Date: 2010 Jul-Aug Impact factor: 1.756
Authors: Chan-Yu Lin; Gareth W Roberts; Ann Kift-Morgan; Kieron L Donovan; Nicholas Topley; Matthias Eberl Journal: J Am Soc Nephrol Date: 2013-10-31 Impact factor: 10.121