Peritoneal dialysis in incident patients with primary glomerulonephritis. Results of a 20-year multicenter registry study

María Díaz Cuevas; Ramón Limón Ramírez; Francisco Javier Pérez Contreras; Carmen Gómez Roldán; Grupo Levante de Diálisis Peritoneal

doi:10.1016/j.nefro.2020.05.009

Peritoneal dialysis in incident patients with primary glomerulonephritis. Results of a 20-year multicenter registry study

Nefrologia (Engl Ed). 2021 Jan-Feb;41(1):53-61. doi: 10.1016/j.nefro.2020.05.009. Epub 2020 Aug 14.

[Article in English, Spanish]

Authors

María Díaz Cuevas¹, Ramón Limón Ramírez², Francisco Javier Pérez Contreras³, Carmen Gómez Roldán⁴; Grupo Levante de Diálisis Peritoneal

Affiliations

¹ Servicio de Nefrología, Hospital General Universitario de Alicante, Alicante, España. Electronic address: mariadiaz@coma.es.
² Subdirección General de Evaluación de la Gestión Asistencial, Dirección General de Asistencia Sanitaria, Conselleria de Sanitat Universal i Salut Pública, Valencia, España.
³ Servicio de Nefrología, Hospital General Universitario de Alicante, Alicante, España.
⁴ Servicio de Nefrología, Hospital General Universitario de Albacete, Albacete, España.

PMID: 32800597
DOI: 10.1016/j.nefro.2020.05.009

Abstract

Background and objectives: Glomerulonephritis (GN) is one of the main causes of chronic terminal kidney disease; however, few studies assess its prognosis in dialysis. We analyze the survival and characteristics of patients on peritoneal dialysis (PD) with primary GN (PGN), and compare their results with other kidney patients.

Methods: This prospective observational study took place from 1995 to 2014. We included all incident patients who were initiated on the technique in the Levante registry. Data were transferred to an anonymized database in Access. Statistical analysis was performed using SPSS software (version 19.0).

Results: The study included 2,243 patients, with GN representing the main cause of primary kidney disease (21,5%). IgA nephropathy was the most frequent histologically confirmed form of PGN. Compared with the rest of the sample, patients with PGN were more often men (65% vs 58%, P=.004), and they were on average younger (48 years vs 55 years, P<.001). They also had fewer comorbidities and a higher rate of inclusion on the waitlist for a kidney transplant (87 vs 63%, P<.001). Patients with PGN also had more transplants (48,9%, P<.001), and this was the most frequent reason for stopping PD; beyond that, their peritonitis mean rate was lower (0,34 vs 0,45 episodes/patient-year, P<.001). Technique survival was 90,6% at one year, 71,7% at 3 years, and 59,0% at 5 years (median 76,8 months); there were no differences between groups. Survival was 94,9% at one year, 80,1% at 3 years, and 63,7% at 5 years (median 90,7 months). Patients with PGN showed better mean survival than patients with other kidney pathologies (153,5 months [95% IC: 137,0 to 169,9] vs 110,3 months [95% CI: 100,8 to 119,7], P<.001). In the multivariable analysis, the main negative risk factor influencing technique survival was a higher peritoneal transport (P=.018). Factors with a negative influence on mortality were being older (P <.001) and having any comorbidity, mainly diabetes and liver disease (P <.001). By contrast, protective survival factors were inclusion on the transplant waitlist and a higher baseline residual renal function (P=.001).

Conclusions: PD has several advantages as a first dialytic treatment, and our results suggest that it is an excellent technique to manage patients with PGN while they await a kidney transplant.

Keywords: Diálisis peritoneal; Glomerulonefritis primarias; Patient survival; Peritoneal dialysis; Primary glomerulonephritis; Supervivencia paciente; Supervivencia técnica; Technique survival.