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Nephrol Dial Transplant (2001) 16: 1996-2001
© 2001 European Renal Association-European Dialysis and Transplant Association
Dialysis and Transplantation News
Should CAPD be the first choice for dialysis in Romania? Audit of the Iasi ‘C. I. Parhon’ Dialysis Center: 1995–2000
‘C. I. Parhon’ University Hospital Dialysis and Transplantation Center, Iasi, Romania
Abstract
Peritoneal dialysis was first introduced in Romania in 1995. We are reporting data on patient and technique outcomes, based on the 5-year experience of one of the first two Romanian continuous ambulatory peritoneal dialysis (CAPD) centres. During this period, Romania had the highest rate of increase in renal replacement therapy (RRT) and CAPD (28 times over baseline) in Europe: CAPD increase in Romania vs Eastern Europe was 6.7 compared to a similarly defined ratio of 5.6 for haemodialysis (HD).
Between 1995 and 2000, at the ‘C. I. Parhon’ Hospital in Iasi, 259 patients were started on HD and 102 on CAPD. The 90 CAPD patients we followed were treated for a total of 1896 months. 86.7% of the patients were alive on 31 July 2000—67.8% continuing on CAPD, 15.6% on HD and 3.3% transplanted. The 61 patients still on PD on that date, represented 11.1% of the actual Romanian CAPD population and 31% of our RRT population (compared to 13.7% nationwide).
The gross mortality rate was comparable to the mean calculated for the HD population nationwide. Mean survival of the CAPD patients was 45.4±2.6 months (95% CI=40.4–50.4 months). One-year and 5-year patient survival rates were 97.5% and 52.7% respectively, superior and similar to mean figures nationwide. Mean technique survival was 36.6±0.6 months (95% CI=31.5–41.6 months). One- and 5-year technique survival rates were 83.1% and 34.3% respectively. Technique failure was mainly due to dialysis inefficiency: 50% of cases. Mean weekly Kt/V for the 5-year period was 1.92±0.21 while mean weekly creatinine clearance was 61.2±12.4 ml/1.73 m2/week.
Eighty-four episodes of peritonitis were recorded in 46 patients (0.25 episodes/patient/year); mean duration to peritonitis was 23 months (95% CI=18.2–27.5). Malnutrition was noted (SGA score) in 25.5% of the cases. Blood pressure (assessed by 24-h ABPM) was adequately controlled in 83.3% of the patients. Left ventricular hypertrophy was ubiquitous (77.7%), but left ventricular dilatation and systolic dysfunction (fractioning shortening index <25%) were rare—4.4% and 3.3% respectively (similar in prevalence to the Iasi HD population). No statistically significant changes in echocardiographic parameters were recorded between the first and subsequent years on CAPD treatment.
Peritoneal dialysis had a rapid increase in the last 5 years in Romania and particularly in the region of Moldova. Outcomes and complication rates are equal or superior to nationwide HD data and comparable to distinguished centres of CAPD in economically developed countries. We conclude that, provided that optimal medical practice is available, CAPD should be the RRT of choice in Romania, and that it represents the only solution to the country's limited dialysis resources.
Keywords: continuous ambulatory peritoneal dialysis; haemodialysis; treatment modalities; complications; survival
Notes
Correspondence and offprint requests to: Dr Adrian Covic MD, PhD, ‘C. I. Parhon’ University Hospital Dialysis and Transplantation Center Medical Director, Blvd. Carol I, No. 50, Iasi 6600, Romania. Email: nefro{at}mail.dnts.ro
* No comparable data for other Romanian CAPD populations.
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