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Pre-dialysis renal clinic visits and patients’ outcomes on peritoneal dialysis

International Urology and Nephrology volume 48, pages 1911–1917 (2016)Cite this article

Abstract

Purpose

To investigate the effect of pre-dialysis renal care on peritoneal dialysis (PD) patients’ outcomes in China.

Methods

In this retrospective cohort study, patients who started PD during January 1, 2006, to December 31, 2014, were included. Patients’ medical charts were reviewed to extract the information. To explore the effect of pre-dialysis renal care on patients’ outcomes, patient were divided into two groups according to whether or not they had frequent renal clinic visits: Group A (with frequent visits) and Group B (without frequent visits).

Results

A total of 668 patients were included. Patients who admitted to emergency room before PD initiations were significantly higher in Group B than in Group A (42.7 vs. 33 %, p = 0.01). However, there was no significant difference in the proportion of patients requiring emergency hemodialysis prior to PD commencement (20.5 vs. 24.6 %, p = 0.21), acute heart failure (30.2 vs. 35.4 %, p = 0.16) and pulmonary infection (15.4 vs. 12.1 %, p = 0.23) between groups. Both the mortality and technical failure rate in Group A were significantly lower as compared to Group B (p = 0.003 and p < 0.01, respectively). Multivariable Cox regression analysis showed frequent pre-dialysis renal clinic visits were associated with both lower mortality rate (HR 0.62, 95 % CI 0.46–0.85, p = 0.003) and technical failure on PD (HR 0.58, 95 % CI 0.36–0.92, p = 0.022).

Conclusion

Pre-dialysis frequent clinic visits were associated with better PD outcomes. Pre-dialysis renal clinic management was suboptimal in the present cohort. More organized system to ensure people with established chronic kidney disease are well managed is necessary in China.

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References

  1. Baer G, Lameire N, Van Biesen W (2010) Late referral of patients with end-stage renal disease: an in-depth review and suggestions for further actions. NDT Plus 3(1):17–27. doi:10.1093/ndtplus/sfp050

    PubMed  Google Scholar 

  2. Bello AK, Levin A, Manns BJ, Feehally J, Drueke T, Faruque L, Hemmelgarn BR, Kernahan C, Mann J, Klarenbach S, Remuzzi G, Tonelli M, Kidney Health for Life I (2015) Effective CKD care in European countries: challenges and opportunities for health policy. Am J Kidney Dis 65(1):15–25. doi:10.1053/j.ajkd.2014.07.033

    Article  PubMed  Google Scholar 

  3. Couser WG, Remuzzi G, Mendis S, Tonelli M (2011) The contribution of chronic kidney disease to the global burden of major noncommunicable diseases. Kidney Int 80(12):1258–1270. doi:10.1038/ki.2011.368

    Article  PubMed  Google Scholar 

  4. Zhang L, Wang F, Wang L, Wang W, Liu B, Liu J, Chen M, He Q, Liao Y, Yu X, Chen N, Zhang JE, Hu Z, Liu F, Hong D, Ma L, Liu H, Zhou X, Chen J, Pan L, Chen W, Wang W, Li X, Wang H (2012) Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet 379(9818):815–822. doi:10.1016/S0140-6736(12)60033-6

    Article  PubMed  Google Scholar 

  5. Yu X, Yang X (2015) Peritoneal dialysis in China: meeting the challenge of chronic kidney failure. Am J Kidney Dis 65(1):147–151. doi:10.1053/j.ajkd.2014.08.023

    Article  PubMed  Google Scholar 

  6. Luckett T, Sellars M, Tieman J, Pollock CA, Silvester W, Butow PN, Detering KM, Brennan F, Clayton JM (2014) Advance care planning for adults with CKD: a systematic integrative review. Am J Kidney Dis 63(5):761–770. doi:10.1053/j.ajkd.2013.12.007

    Article  PubMed  Google Scholar 

  7. Mendelssohn DC, Curtis B, Yeates K, Langlois S, MacRae JM, Semeniuk LM, Camacho F, McFarlane P, Investigators SS (2011) Suboptimal initiation of dialysis with and without early referral to a nephrologist. Nephrol Dial Transplant 26(9):2959–2965. doi:10.1093/ndt/gfq843

    Article  PubMed  Google Scholar 

  8. Smart NA, Titus TT (2011) Outcomes of early versus late nephrology referral in chronic kidney disease: a systematic review. Am J Med 124(11):1073–1080. doi:10.1016/j.amjmed.2011.04.026

    Article  PubMed  Google Scholar 

  9. Goransson LG, Bergrem H (2001) Consequences of late referral of patients with end-stage renal disease. J Intern Med 250(2):154–159

    CAS  Article  PubMed  Google Scholar 

  10. Chow KM, Szeto CC, Law MC, Kwan BC, Leung CB, Li PK (2008) Impact of early nephrology referral on mortality and hospitalization in peritoneal dialysis patients. Perit dial int J Int Soc Perit Dial 28(4):371–376

    Google Scholar 

  11. Wu MS, Lin CL, Chang CT, Wu CH, Huang JY, Yang CW (2003) Improvement in clinical outcome by early nephrology referral in type II diabetics on maintenance peritoneal dialysis. Perit dialysis int J Int Soc Perit Dial 23(1):39–45

    Google Scholar 

  12. Lin CL, Chuang FR, Wu CF, Yang CT (2004) Early referral as an independent predictor of clinical outcome in end-stage renal disease on hemodialysis and continuous ambulatory peritoneal dialysis. Ren Fail 26(5):531–537

    Article  PubMed  Google Scholar 

  13. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J, Ckd-EPI (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150(9):604–612

    Article  PubMed  PubMed Central  Google Scholar 

  14. Griva K, Lai AY, Lim HA, Yu Z, Foo MW, Newman SP (2014) Non-adherence in patients on peritoneal dialysis: a systematic review. PLoS One 9(2):e89001. doi:10.1371/journal.pone.0089001

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hughes SA, Mendelssohn JG, Tobe SW, McFarlane PA, Mendelssohn DC (2013) Factors associated with suboptimal initiation of dialysis despite early nephrologist referral. Nephrol Dial Transplant 28(2):392–397. doi:10.1093/ndt/gfs431

    Article  PubMed  Google Scholar 

  16. Titze S, Schmid M, Kottgen A, Busch M, Floege J, Wanner C, Kronenberg F, Eckardt KU, Investigators Gs (2015) Disease burden and risk profile in referred patients with moderate chronic kidney disease: composition of the German Chronic Kidney Disease (GCKD) cohort. Nephrol Dial Transplant 30(3):441–451. doi:10.1093/ndt/gfu294

    Article  PubMed  Google Scholar 

  17. Levin A, Lewis M, Mortiboy P, Faber S, Hare I, Porter EC, Mendelssohn DC (1997) Multidisciplinary predialysis programs: quantification and limitations of their impact on patient outcomes in two Canadian settings. Am J Kidney Dis 29(4):533–540

    CAS  Article  PubMed  Google Scholar 

  18. Goldstein M, Yassa T, Dacouris N, McFarlane P (2004) Multidisciplinary predialysis care and morbidity and mortality of patients on dialysis. Am J Kidney Dis 44(4):706–714

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported by Chinese Society of Nephrology (No. 1405046058), Fund of Peking University Third Hospital (76496-03) and Beijing Municipal Science and Technology Commission (No. D131100004713002).

Author information

Affiliations

  1. Division of Nephrology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, China

    Wen Tang, Xiu-Hong Hu, Lei Zhu, Zhe-Li Niu, Chu-Yan Su, Qing-Feng Han & Tao Wang

  2. School of Chinese Integrative Medicine, Hebei Medical University, Shijiazhuang, China

    Xiu-Hong Hu & Zhe-Li Niu

  3. Division of Nephrology, The First Hospital of Hebei Medical University, Shijiazhuang, China

    Xiu-Hong Hu & Zhe-Li Niu

  4. Division of Nephrology, The Second People’s Hospital of Yibin, Yibin, China

    Lei Zhu

Authors
  1. Wen Tang
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  2. Xiu-Hong Hu
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  3. Lei Zhu
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  4. Zhe-Li Niu
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  5. Chu-Yan Su
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  6. Qing-Feng Han
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  7. Tao Wang
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Corresponding author

Correspondence to Qing-Feng Han.

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The authors declared no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study formal consent is not required. The study protocol was approved by the Medical Scientific Research Ethical Committee of Peking University Third Hospital (No. IRB00006761-2015246).

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Tang, W., Hu, XH., Zhu, L. et al. Pre-dialysis renal clinic visits and patients’ outcomes on peritoneal dialysis. Int Urol Nephrol 48, 1911–1917 (2016). https://doi.org/10.1007/s11255-016-1400-2

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  • DOI: https://doi.org/10.1007/s11255-016-1400-2

Keywords

  • Chronic kidney disease
  • Outcomes
  • Peritoneal dialysis
  • Pre-dialysis