NDT Advance Access published online on September 12, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn372
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Comparison of peritoneal dialysis practice patterns and outcomes between a Canadian and a Chinese centre
1 Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China 2 Peritoneal Dialysis Program, University Health Network and University of Toronto, Toronto, Ontario, Canada
Correspondence and offprint requests to: Dimitrios G. Oreopoulos, University Health Network, Toronto and University of Toronto, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada. Tel: +416-603-7974; Fax: +416-603-5189. E-mail: dgo{at}teleglobal.ca; dimitrios.oreopoulos{at}uhn.on.ca
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Abstract |
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Objective. We compared patient characteristics, dialysis practice patterns and outcomes of peritoneal dialysis (PD) patients between one Chinese centre and one Canadian centre to determine whether observed differences in demographics and practices are associated with patient and technique survival.
Methods. This study included all patients who started on PD between 1 January 2000 and 31 December 2004 at the University Health Network, University of Toronto, Canada and Renji Hospital, Shanghai Jiao Tong University School of Medicine, China. They were followed up from the date of PD initiation until death, cessation of PD, transfer to other centres or to the end of the study (31 December 2006).
Results. We studied 496 patients, 256 from the Canadian centre and 240 from the Chinese centre. Canadian patients were older and more likely to have diabetes and cardiovascular comorbidities at the initiation of PD, while the Chinese patients had lower residual renal function (RRF). More Canadian patients were treated with APD, whereas all Chinese patients were on CAPD with a lower PD volume. Crude patient survival rates at 1, 2, 3 and 5 years were similar between the two centres: 90%, 79%, 72% and 61% for Canadian and 90%, 79%, 71% and 64% for Chinese patients, respectively. After adjustment for demographic and clinical variables, there is no significant difference in mortality between Chinese patients and Canadian patients. Age, cardiovascular disease, diabetes, RRF and serum albumin were independent predictors of patient survival. The death-censored technique survival rates were significantly lower among the Canadian patients compared to Chinese patients. Chinese patients showed a lower risk of technique failure (HR 0.491, 95% CI 0.269–0.898, P = 0.021) after adjustment for patient characteristics. Chinese centre, BMI, serum albumin and gender were independent predictors of technique survival. The average peritonitis rate was one episode every 36.1 patient-months in Canadian patients and one episode every 60.6 patient-months in their Chinese counterparts.
Conclusion. Patient characteristics, dialysis practice patterns and outcomes vary between Canadian and Chinese patients. The variability in patient outcomes between these two centres indicates that further improvements may be possible in both centres. We have identified several areas for improving outcomes.
Keywords: mortality; peritoneal dialysis; peritonitis rate; risk factor; technique survival
Received for publication: 9.11.07
Accepted in revised form: 10. 6.08