Méndez DA, Fermín PJG

Language: Spanish
References: 12
Page: 199-203
PDF size: 55.65 Kb.

ABSTRACT

Introduction: The peritoneal dialysis is a life alternative that improves the quality of life of the patients with chronic renal failure (FRC). The causes of death in these patients are cardiovascular, infectious and malnutrition. The General Hospital Regional 25 of the IMSS counts with 650 patients in PD, 60% is dealt with ambulatory continuous DP (CAPD), in this unit has not described the frequency of mortality in these programs, the death causes and it has not been compared if there is difference between the two modalities. Objective: To compare the causes of death between the ambulatory continuous peritoneal dialysis and the automated. Material and methods: Retrospective and comparative study of 3 years, realized in the Service of Nephrology of the General Hospital Regional number 25 of the IMSS. In includes patients of CAPD and APD, identifies the causes of CRF, gender, age, the time in dialysis, number of peritonitis, serum albumin (g/dL), total cholesterol (CT), triglycerides (TGD), hemoglobin (Hb), hematocrit (Ht%) and the causes of death, which are divided in happened in diabetic population and the nondiabetic; ranks, averages and standard deviation are obtained; and the results between the two modalities applying the difference of proportions, accepted significance with a value of p ‹ 0.05. Results: In 36 months of study 989 patients entered to DPCA, in the first year of treatment in both programs happened 480 (48.5%) deaths, 236 (49%) were intradomiciliary and the precise cause was not known, only 244 (51%) files was analyzed, corresponded 118 (48%) to female ones and 126 to male (52%), with age average of 67 years (mg: 41 to 78). The main causes of the IRC were the diabetes mellitus type 2 in 154 cases (63%), systemic arterial hypertension 50 (20.5%), chronic glomerulopathies 28 (11.5%) and obstructive uropathy 12 (5%). Were 133 deaths (54.5%) in CAPD and 111 (45.4%) in APD. Death in CAPD and APD were cardiac failure 58 and 56, sepsis 35 and 24, cerebral vascular event 17 and 15, heart infarct 17 and 5, digestive bleeding 5 and 4, and pulmonary acute edema 3 and 5. The permanence in CAPD was of 22 months (rng: 4 to 36; DS 8.5) and in APD 22.09 (rng: 1 to 36; DS 8.7) p ≥ 0.6. Were 12 episodes of peritonitis in CAPD and 8 in DPA (p = 0.6). The values of serum albumin were 3.35 (rng: 2.3 to 4,2; DS 0.4) and 3.3 (rng: 2.8 to 4,1; DS 0.4) p = 0.6; the TC was 215.5 of mg/dL (rng: 65 to 412; DS 65.9) and of 270 (rng: 89 to 424; DS 87.8), p = 0.05; the TGD of 215.66 mg/dL (rng: 84 to 280; DS: 54,1) and 268.4 (mg: 167 to 324; 67.3 DS) p = 0.05; the hemoglobin and hematocrit did not present significant statistical difference. Conclusions: The mortality frequency is high, the death causes and the frequency were similar in the two techniques, with greater predominance in the diabetic population.

REFERENCES

1. Rabindranath KS, Adams J, Ali T, Daly C et al. Automated vs continuous ambulatory peritoneal dialysis: a systematic review of randomized controlled trials. Nephrol Dial Transplant 2007; 22(10): 2991-98.

2. Goldfarg-Rumyantzev AS, Baird DC, Leyopold JK, Cheung AK. The association between BP and mortality in patients on chronic peritoneal dialysis. Nephrol Dial Transplant. 2005; 20(8): 1693-1701.

3. Scott BK, Walker M, Margetts PTJ et al. Meta-analysis: peritoneal membrane transport, mortality and technique failure in peritoneal dialysis. J Am Nephrol 2006; 17: 2591-98.

4. Bargman JM, Thorpe KE, Churchill DN. Relative contribution of residual renal function and peritoneal clearance to adequacy of dialysis: a reanalysis of the CANUSA study. J Am Soc Nephrol 2001; 12: 2158-62.

5. American Society of Nephrology. Adequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcomes. Canada-USA (CANUSA) Peritoneal Dialysis Study Group. J Am Soc Nephrol 1996; 7: 198-207.

6. Is peritoneal dialysis associated with increased cardiovascular morbility and mortality? Perit Dial Int 2006 (26): 429-34.

7. Habib A, Baird B, Leyopold J et al. The association of lipids levels with mortality in patients on chronic peritoneal dialysis. Nephrol Dial Transpl 2006: 1-12.

8. Ronco C et al. MIA Syndrome in peritoneal dialysis: prevention and treatment. Peritoneal Dialysis: A clinical Update 2006; 150: 135-43.

9. Yee-Moon WA. The Heart of Peritoneal dialysis: residual renal function. Perit Dial Int 2007; 27: 116-124.

10. Torres PJ y cols. Causas de muerte en diálisis peritoneal continua ambulatoria en el ISSSTE. Estudio multicéntrico. Nefrología Mexicana 2001; 22(4): 189-93.

11. U.S. Renal Data System. USRDS. Annual Date Report. Atlas of end Stage Renal Disease in he United States. 2003. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. 2004.

12. Paniagua R, Amato D, Vonesh E et al. Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis: ADEMEX, a prospective, randomized, controlled trial. J Am Soc Nephrol 2002; 13: 1307-20.