Risk Factors of Technique Failure in CAPD: Can We Improve Patient Selection?
黃士婷(Shih-Ting Huang)；荘雅雯(Ya-Wen Chaung)；陳呈旭(Cheng-Hsu Chen)；吳明儒(Ming-Ju Wu)；鄭志雄(Tung-Min Yu)；游棟閔(Chi-Hung Cheng)；徐國雄(Kuo-Hsiung Shu)
technique failure ； peritoneal dialysis ； patient survival
|Volume or Term/Year and Month of Publication||
23卷1期（2009 / 03 / 01）
6 - 14
Background: The major causes of technique failure in long-term studies include peritonitis, inadequate dialysis, as well as non-coping and catheter problems. In particular, some patients may have early technique failure, which results in significant morbidity and mortality thereafter. The attn of the present study is to determine the risk factors of early withdrawal in incident CAPD patients. Methods: Uremic patients undergoing PD in our center between June 1, 2002, and June 31, 2007 were enrolled for the study. Early technique failure was defined as withdrawal from CAPD within 24 months after starting PD, and this group was denoted as the 'early technique failure' group (Group 1). Those patients who underwent kidney transplantation, had previous history of hemodialysis or transplantation or started PD within 6 months were excluded. Pre-diulysis parameters including age, education level, underlying comorbidities, markers far nutrition and chronic inflammation, as well as membrane transport characteristics were analyzed and compared between patients with and without early technique failure. Results: A total of 144 patients were recruited (61 male and 83 female). The mean age was 50.3±16.3 years and the follow-up duration was 28.1±20.4 months. Of them, 30 cases (20.8%) had early failure within 24 months (Group Ⅰ). The others had technical survival for ＞ 24 months (Group 2). Group Ⅰ patients were significantly less educated, required more assistance with dialysis procedures, had more malignant diseases and suffered higher peritonitis rate. Compared with those of Group 2. Group Ⅰ Patients also had significantly higher pre-dialysis C-reactive protein level, but lower pre-dialysis serum calcium, iron and total iron binding capacity levels. After multiple Cox regression analysis, variables identified to be associated with an increased likelihood of early technique failure were: low education level (OR: 4.37, 95% C.I. 1.03-18.62, P=0.04), higher pre-dialysis serum C-reactive protein level (OR: 1.29.95% C.I. 1.00-1.65, P=0.04), and higher peritonitis rate (OR: 2.07, 95% C.I. 1.45-2.96, p＜0.001), Age and diabetes mellitus were clear predictors of patient survival, hut did not appear to influence technique survival in our study. Conclusion: Low education level and higher pre-dialysis C-reactive protein level were significant risk factors of technique failure of PD within 2 years in our study. Technique success in patients on CAPD was equal so that in patients an APD. After initiating PD. higher peritonitis rate also significantly leads so technique failure. Age and diabetes mellitus were clear predictors of patient survival, but did not appear to influence technique survival in our study. These findings may citable better selection of patients far CAPD and enhance technique success.