Mechanical, metabolic and infectious complications in continue ambulatuar peritoneal dialysis patients

AIM: Chronic kidney disease may progress to End-Stage Renal Failure (ESRF) due to progressive nephron loss over a variable period. Renal Replacement Therapy (RRT) is the only chance of survival in patients at the terminal stage. Peritoneal Dialysis (PD) is one of the renal replacement therapies used in the treatment of patients with ESRF and it is based on the principle of using peritoneum as a dialysis membrane. Manually operated continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (DPD) operated by a device are the standard forms of peritoneal dialysis. Despite being simple, comfortable, and cheap and thus successfully used in patients with end-stage renal disease, various complications occur with its prolonged use. We therefore aimed to investigate the complications observed in patients undergoing PD at our institution. MATERIALS AND METHODS: This study investigated mechanical, metabolic, and infectious complications in patients followed at İnönü University Faculty of Medicine Department of Nephrology, Peritoneal Dialysis Center between January 2004 and January 2014. The medical data of the patients were accessed retrospectively via medical records kept at peritoneal dialysis center. Patients who had missing demographic, clinical, and laboratory data, who were younger than 18 years of age, or who underwent PD for less than one month were excluded from the study. SPSS (Statistical Package For Social Siences) version 17.0 (SPSS, Inc., Chicago, IL, USA) was used for statistical analyses. The categorical variables were presented as number and percentage while numerical variables were expressed as mean and standard deviation (median and minimum -maximum as needed). RESULTS: This study included 202 patients with a mean age of 51,2± 15,8 years, of whom 109 (54%) were male. The most common etiological factors in descending order were HT (23.8%), DM (20.8%), and GN (18.8%). The mean duration of PD therapy was 37,6± 35 (2-156 months). Nine patients had undergone PD for 1-3 months, 43 patients for 4-12 months, 67 patients for 1-3 years, 41 patients for 4-5 years, and 42 patients for equal to or more than 5 years. Of the study population, 91,5% (n=185) were undergoing CAPD and the remainders APD. The risk of peritonitis was significantly higher in patients undergoing APD than those undergoing CAPD (p<0.0001). One hundred and thirteen patients among 202 patients developed at least one peritonitis attack. In 182 patients serum albumin level was less than 3,5 g/dl in at least one measurement, and the rate of hypoalbuminemia was 90%. The rate of hypoalbuminemia was significantly higher in patients that suffered peritonitis than those who did not experience this complication (p<0.0001). No significant difference was found between the mean albumin level of the patients who developed peritonitis and those who did not (p>0.05). Of 202 patients included in the analysis, 89 did not suffer from peritonitis whereas 113 patients developed at least one peritonitis attack. Among those who developed peritonitis, 52 patients developed 1 attack, 31 developed 2 attacks, 8 patients developed 3 attacks, and 22 patients developed 4 or more attacks. The mean number of a peritonitis attacks was 1.31 attack/patient. The mean number of peritonitis attacks was 2.35 attack/patient in the patients who developed peritonitis. The frequency of peritonitis attacks was 0.43 attack/year/patient or 28.1 month/episode. The most common mechanical complications were hernia (17.8%), malposition (16.3%), leakage into abdominal wall (12.3%), dialysate discharge failure (10.8%), and catheter occlusion (7.4%). The most common metabolic complications were anemia (99%), hyperlipidemia (92%), hypoalbuminemia (90%), hyponatremia (82.1%), Vitamin D deficiency (70.7%), hyperkalemia (36.1%), hyperglycemia (13.8%), obesity (11.8%), and cachexia (8.4%). Other complications of PD were constipation (32.1%), UF failure (16.3%), hemorrhoids (16.3%), parathyroid adenoma (2.9%), and peritoneal sclerosis (0.4%). One hundred and eleven (55%) patients continued PD program while 91 patients (45%) discontinued it owing to various reasons. Drop-out reasons were death (46.2%), renal transplantation (24.2%), transfer to HD (20.8%), and other reasons (8.8%). CONCLUSION: Mechanical, metabolic and infectious complications are seen during PD that is a form of RRT. Although infectious complications are considered the most serious ones, they were effectively reduced to acceptable rates. Apart from infections, particularly metabolic (anemia, hyperlipidemia, hypoalbuminemia, hyponatremia) and mechanical (hernia, malposition, leakage into abdominal wall) complications are common in PD patients.