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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2011  |  Volume : 22  |  Issue : 1  |  Page : 40-48
Outcome of patients treated with automated peritoneal dialysis: Effects of selection of patients

Kanoo Kidney Center, Dammam Medical Complex, Dammam, Saudi Arabia

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Date of Web Publication30-Dec-2010


To determine the effect of selection of peritoneal dialysis patients who used auto­mated PD (APD) as a first renal replacement therapy (RRT) option, we studied two groups of adult chronic kidney disease (CKD) patients treated with APD over a period of 4 years: group 1 included 30 patients in whom APD was the first choice for RRT and group 2 included 40 patients transferred from failed hemodialysis (HD) treatment. Both groups were matched for the original causes of CKD and comorbid conditions. However, group 1 had significantly higher residual renal function (RRF) than group 2 [glomerular filtration rate (GFR) 11.85 ± 4 mL/min and urine output 995 ± 465 mL/day vs. 3.69 ± 3.7 mL/min and 340 ± 447 mL/day, respectively, P = 0.0001] and Kt/v (2.7 ± 0.7 vs. 1.9 ± 0.4, respectively, P = 0.006). Most of the patients were compliant with their APD prescription, performed ideal PD techniques, achieved adequate dialysis and fluid ultra­filtration, and experienced much less than average infectious and non-infectious complications. However, group 1 achieved better clinical outcome than group 2, including relatively higher sur­vival rate and kidney transplantation, significantly fewer episodes of peritonitis per year (0.09 vs. 0.14, respectively, P = 0.0001), higher serum albumin (2.95 ± 0.3 vs. 2.7 ± 0.27 g/dL, respectively, P = 0.035), hemoglobin (11.5 ± 0.9 vs. 10.6 ± 0.7 g/dL, respectively, P = 0.022) and lower para­thormone levels (283 ± 117 vs. 389 ± 269 pg/mL, respectively, P = 0.02). They also maintained significantly higher total fluid removal compared to group 2 (1120 ± 330 vs. 560 ± 300 mL/day, respectively, P = 0.004), higher RRF (GFR 8 ± 2.6 mL/min vs. 1.8 ± 2.4 mL/min, respectively, P = 0.0001), and urine output (556 ± 447 mL/day vs. 240 ± 347 mL/day, respectively, P = 0.004), and significantly higher Kt/v (2.8 ± 0.7 vs. 1.9 ± 0.4, respectively, P = 0.2). In conclusion, in CKD patients, PD is a viable initial modality of RRT, and with better RRF may have a better outcome than as a secondary choice.

How to cite this article:
Karkar A, Abdelrahman M. Outcome of patients treated with automated peritoneal dialysis: Effects of selection of patients. Saudi J Kidney Dis Transpl 2011;22:40-8

How to cite this URL:
Karkar A, Abdelrahman M. Outcome of patients treated with automated peritoneal dialysis: Effects of selection of patients. Saudi J Kidney Dis Transpl [serial online] 2011 [cited 2022 Oct 2];22:40-8. Available from: https://www.sjkdt.org/text.asp?2011/22/1/40/74340

   Introduction Top

Peritoneal dialysis (PD), when there are no contraindications, can be an excellent first treat­ment option for renal replacement therapy (RRT) program [1],[2],[3] with equivalent or better survival rate, especially among non-diabetic and younger diabetic patients, than hemodialysis (HD) during the first 1-2 years of therapy. [3],[4],[5],[6] Furthermore, PD has the benefits of preserving residual renal function (RRF), delaying the need for vascular access and helping patients with multiple vascular access failure, forming a better option for older age groups, especially those with cardiovascular disease, [7],[8] and pro­moting home self-care. [1]

PD has become even more attractive follo­wing the recent availability of new PD solu­tions such as icodextrin and amino acid-based, [9],[10] biocompatible PD fluids, [11] better connecting systems with significant reduction in perito­nitis rate, and a new generation of automated cycler dialysis machines. [12] Studies have docu­mented that if patients are given informed choice of dialysis treatment, 40-60% will chose PD modality. [13],[14],[15],[16] In addition, when comparing patient satisfaction with modality of HD ver­sus PD as in CHOICE study, patients on PD therapy were more satisfied. [17] Furthermore, pa­tients on PD modality from New Haven study were not only more satisfied with their care, but also they felt less significant impact of PD on their lives. [18]

Globally, it has been estimated that approxi­mately one-third of PD patients are being main­ tained on automated PD (APD) treatment. [19],[20],[21]

In contrast with continuous ambulatory perito­neal dialysis (CAPD), the efficacy of APD, es­pecially in high and high-average peritoneal transport membranes, [22] its higher [19] or simi­lar [23],[24] patient and technique survival rates, reduced peritonitis rates, [19],[25],[26] similar extracellular fluid volume and blood pressure control and sodium removal [27] or enhanced ultrafiltra­tion, [28] avoidance of high intraperitoneal pressure and decreased mechanical complications, [29] home therapy and improved quality of life with more freedom for patients to fulfill their employ­ment and lifestyle, [30] all enhanced the popularity of APD modality. These advantages have been confirmed even for anuric patients as demons­trated in the European Automated Peritoneal Dialysis Outcome (EAPOS) study [31]

The aim of this study was to examine the influence of selection of chronic kidney di­sease (CKD) patients for PD, whether applied as an initial option of RRT or as a second choice for patients with failed HD, on clinical outcome and on achievement and maintenance of successful APD treatment.

   Materials and Methods Top

In our PD clinic, an APD program has been established in collaboration with Baxter Health­care in 2004. We report our experience with 70 patients who were initiated and maintained on APD during 4 years.

Practical training of patients and/or relatives on APD Homechoice dialysis machine (theore­tical and practical) lasted on an average of 2-3 weeks. Adequate training resulted in achieving full application of aseptic techniques, easy con­nection and disconnection of machine, priming time of about 10 min and total preparation of machine for about 15 min.

We analyzed the data of two subgroups of the 70 studied patients. In group 1 (30 patients), APD was the first choice and initial treatment option in newly recruited patients of stage 4 CKD from the outpatient clinic. Patients were selected according to their clinical suitability and on the basis of their informed choice and decision. This group had the chance of re­ceiving adequate education and training before com-mencing APD treatment. The age in this group varied between 14 and 92 years (50 ± 20 years) and included 9 males and 21 females [Table 1]. The main original diseases in these patients included diabetic nephropathy in 5 3% (n = 14), hypertension in 23% (n = 7), and glo­merulonephritis in 14% (n = 6). The comorbid conditions included diabetes mellitus in 53% of patients, hypertension in 60%, and cardio­vascular disease in 30%; none of the patients developed malignancy or were serologically positive for hepatitis C or hepatitis B.
Table 1: Initial parameters in patients who selected APD as the first RRT choice compared with those of patients transferred from HD to APD as the second RRT choice.

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In group 2 (40 patients), APD was initiated upon transfer from HD. The patients were on regular HD treatment from 7 to 118 months before the transfer; the majority (n = 33, 82.5%) were transferred due to failed vascular access and the rest (n = 7, 17.5%) were offered APD to suit their lifestyle and accepted it as a se­cond RRT choice. All the patients in group 2 did not have equivalent pre-dialysis chance of education and preparation as in group 1, but received adequate PD practical training. Age of the patients in this group varied between 16 and 96 years (61 ± 17), which was signifi­cantly higher than in the first group (P = 0.01), and there were equal numbers of male and fe­male patients (n = 20). The frequency of main original diseases, and comorbid conditions were not statistically different from those of group 1 patients [Table 1], but three patients were posi­tive for antibodies to hepatitis C.

At the beginning of the study, the initial he­moglobin, parathormone levels, and biochemi­cal parameters, including serum albumin, were not statistically different between both groups. However, patients in group 1, as expected, had statistically higher initial RRF, total fluid re­moval, creatinine clearance and dialysis ade­quacy, as shown in [Table 1].

The usual average PD prescription included the following steps: APD starts at 10 p.m.-12 p.m. and ends at 8 a.m.-10 a.m. The dialysis duration time lasts 8-12 hours, 4-6 cycles/ night, infused volume 2-2.5 L/cycle of 1.36% solution, dwell time 1-2 hours, daytime dwell (when indicated) 12-16 hours and total fill volume used 10-14 L/night, though all patients were supplied with 15 L/night. Adequacy was tested after 1 month and peritoneal equilibra­tion test (PET) was performed after 6 weeks. There was no low transporter type of peritoneal membrane among all patients, but similar number with low-average and high-average membrane, with only two patients with high transporter peritoneal membrane.

The patients were evaluated on a regular basis in the PD clinic to adjust PD prescription according to the patients' needs, and to ensure the adequacy of treatment and absence of com­plications. Patients were instructed and encou­raged to contact the PD team during and after the working hours in case of any sign or symp­tom or query regarding any technical problem.

   Statistical Analysis Top

Continuous variables were reported as mean ± standard deviation (Mean ± SD) and com­pared using Student's "t" test. A P value <0.05 was considered statistically significant. Statis­tical analysis was performed using Medcalc software (Broekstraat 52, B-9030, Mariakerke, Belgium) version ( http://www.medcalc.b6e ).

   Results Top

[Table 2] shows the results at the end of 4 years treatment with APD. Both studied groups a­chieved and maintained adequate therapy, with no significant difference in biochemical results of urea, serum creatinine and creatinine clea­rance [Table 2]. However, group 1 in compa­rison with group 2 maintained significantly higher serum albumin (2.95 ± 0.3 vs. 2.7 ± 0.27 g/dL, respectively, P = 0.035) and hemoglobin (11.5 ± 0.9 vs. 10.6 ± 0.7 g/dL, respectively, P = 0.022) and parathormone levels (283 ± 117 vs. 389 ± 269 pg/mL, respectively, P = 0.02). Furthermore, there was a significant difference between group 1 and 2 in dialysis adequacy (Kt/v 2.8 ± 0.7 vs. 1.9 ± 0.4, respectively, P = 0.02), total fluid removal (1120 ± 330 vs. 560 ± 300 mL/day, respectively, P = 0.004), and RRF (urine output 556 ± 447 vs. 240 ± 347 mL/day, respectively, P = 0.013; and GFR 8 ± 2.6 vs. 1.8 ± 2.4 mL/min, respectively, P = 0.0001). In addition, patients in group 1 re­quired lesser time in comparison to group 2 patients (6.5 ± 1.2 vs. 12 ± 6 days, respec­tively, P = 0.0027) to achieve adequate trai­ning following Tenckhoff catheter insertion, and consequently, shorter hospital stay.
Table 2: Post 4 years APD treatment parameters in patients who selected APD as the first RRT choice compared with those of patients transferred from HD to APD as the second RRT choice.

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[Table 3] shows the infection complications in the study groups. In group 1, peritonitis affec­ted only two patients (7%), with one episode in 134 months of treatment, which was signifi­cantly lesser than in patients in group 2, where there were five patients (13%) with one epi­sode in 87 months of treatment (0.09 vs. 0.14 episodes/year, respectively, P = 0.0001). In contrast, exit site infection affected four pa­tients in group 1 and 11 patients in group 2; however, there was no significant difference in exit site infection between both the groups (0.18 vs. 0.30 episodes/year, respectively). Fi­nally, there was only one episode of tunnel infection in group 1 (a rate of 1 in 267 months of treatment; 0.05 episode/year). Peritonitis in group 1 was due to Klebsiella in one patient and there was no growth in the second patient, while Pseudomonas was the cause of perito­nitis in one case in group 2 and four patients showed no bacterial growth. In both the groups of patients, however, there was no gram-posi­tive bacterial growth of Staphylococcus or Strep­tococcus in peritoneal fluid culture. In con­trast, Staphylococcus aureus Scientific Name Search  was a more com­mon organism cultured from exit site infection in patients in group 2. Most patients were trea­ted adequately and achieved complete res­ponse to treatment in both groups.
Table 3: Comparison of infectious complications between APD as an initial or second choice modality of renal replacement therapy.

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Small number of patients in groups 1 and 2 suffered non-infectious complications, which were not statistically significant. These inclu­ded catheter migration (4 vs. 3, respectively) and ultrafiltration failure (2 vs. 2, respectively). There were no reported cases of leak, inflow or outflow obstruction, or development of hernia or hydrocele.

[Table 4] shows the outcome of the study pa­tients. At the end of 4 years treatment with APD, 20% of patients (n = 6) in group 1 trans­ferred to HD versus 32% (n = 13) in group 2. This was due to catheter migration (n = 4 vs. n = 3, respectively), ultrafiltration failure (n = 2 vs. n = 2, respectively), poor compliance (n = 0 vs. n = 5, respectively), peritonitis (n = 0 vs. n = 2, respectively) and exit site infection (n = 0 vs. n = 1, respectively). There were 20% of patients (n = 6) transplanted in group 1 com­pared with 5% (n = 2) in group 2 and 90% (n = 27) survival rate in group 1 versus 80% (n = 42) in group 2 with overall survival rate of 84%.
Table 4: Outcome of patients in both groups after 4 years of treatment with APD.

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   Discussion Top

Most of our APD patients were compliant with their prescription, performed ideal PD techniques and have achieved adequate dialy­sis and fluid ultrafiltration and experienced much less than average infectious and non-infectious complications.

As a first choice modality, PD offers better preservation of RRF, [32] lower risk of infection with hepatitis B and C, [33],[34] better outcome after transplantation with lower incidence of acute kidney injury and delayed graft function, preservation of vascular access and lower costs than HD. [1] However, HD and PD have been regarded as complementary methods of RRT, where their use is based on medical indications and contraindications, as well as patient's pre­ference in order to achieve best outcomes for the patients. [1],[35] It has been reported that there is 10-20% of PD patients transferred annually to HD due to technical failure, [36] but there has been much smaller proportion change modality from HD to PD, [37],[38] predominantly due to vascular access problems, cardiac disease or patients preference. [39],[40],[41] In these studies, the clinical outcome and survival rate were worse in transferred patients from HD to PD than in patients who had initiated dialysis with PD. This was not attributed to the difference in RRF, [41] but to numerous comorbid conditions, including cardiovascular diseases, diabetes mel­litus and low serum albumin. In comparison, a recent study by Liberek et al, [42] has shown that the outcome of patients transferred from HD may be similar to that achieved in patients in whom PD was the first choice therapy.

However, in their transferred group from HD to PD and when compared with first choice PD group, there were higher levels of hemoglobin, similar levels of serum albumin, insignificant difference in body mass index and signifi­cantly less patients with diabetes mellitus, findings that may confirm the influence of precomorbid conditions on clinical outcome in transferred patients. In our study, patients treated with APD as a first choice option main­tained significantly higher serum albumin and hemoglobin levels and significantly lower nPCR and PTH levels. They have also main­tained significantly higher RRF, total fluid re­moval and adequate dialysis, in addition to shorter post Tenckhoff catheter insertion trai­ning period and hospital stay. There were as well significantly fewer incidences and epi­sodes of peritonitis, fewer patients transferred back to HD (none of them transferred because of poor compliance or unresolved infectious complications), higher patient survival rate, and more patients achieved successful kidney transplantation.

Our findings are in agreement with earlier studies, [39],[40],[41] where clinical outcomes were be­ tter in patients who selected PD as their first modality of RRT than in patients transferred from HD to PD. It is important, however, to notice that the first group patients were signi­ficantly at younger age, and as expected, en­joyed significantly higher RRF, creatinine clea­rance, Kt/v and total fluid removal than the second group patients. The better clinical out­comes can also be attributed to better patients' pre-dialysis educational and training program [42] and the experience and commitment of the PD team, the value of which has been confirmed by other studies. [43],[44] These findings, together with avoidance of vascular access creation and better quality of lifestyle and safety, are in favor of selection of PD as an initial modality choice of RRT, which are compatible with the findings of other reported studies. [41],[45],[46],[47],[48],[49]

The comparable clinical outcome of the study groups may be due to comparable original cau­ses of renal failure, insignificant differences in initial laboratory parameters and similar initial comorbidities despite the differences in the adequacy of dialysis.

Infectious complications and, in particular, repeated episodes of peritonitis were less frequent when compared to other studies. [24],[25],[50] However, rates and episodes of peritonitis were significantly more often in patients transferred from HD to APD than in those who had APD as a first choice, probably due less training and education for the transferred patients. This de­monstrates the benefits of early preparation of renal failure patients approaching stage IV CKD for RRT and, in particular, when selec­ting PD treatment as the first choice option. [51]

In conclusion, in CKD patients, PD is a viable initial modality of RRT, and with better RRF, may have a better outcome than with PD as a secondary choice.

   Acknowledgment Top

The authors are grateful for the assessment and data collection given by Mrs. Huda Al Jafary.

   References Top

1.Lameire N, Van Biesen W, Vanholder R. The role of peritoneal dialysis as first modality in an integrative approach to patients with end-stage renal disease. Perit Dial Int 2000;20 (Suppl 2):S134-41.  Back to cited text no. 1
2.Burkart J. Transitions from PD are expected. Why not continue at home? Perit Dial Int 2007;27:645-6.  Back to cited text no. 2
3.McDonald SP, Marshall MR, Johnson DW, Polkinghorne KR. Relationship between dialy-sis modality and mortality. J Am Soc Nephrol 2009;20:155-63.  Back to cited text no. 3
4.Heaf JG, Lokkegaard H, Madsen M. Initial survival advantage of peritoneal dialysis rela-tive to haemodialysis. Nephrol Dial Transplant 2002;17:112-7.  Back to cited text no. 4
5.Venosh EF, Snyder JJ, Foley RN, Collins AJ. Mortality studies comparing peritoneal dialysis and hemodialysis: what do they tell us? Kidney Int 2006;70:S3-11.  Back to cited text no. 5
6.Liem YS, Wong JB, Hunink MG, de Charro Fort, Winkelmayer WC. Comparison of hemo-dialysis and peritoneal dialysis survival in the Netherlands. Kidney Int 2007;71:153-8.  Back to cited text no. 6
7.Franco MG, Lima G. Peritoneal dialysis in the elderly patients. Perit Dial Int 2007;27:S15.  Back to cited text no. 7
8.Brown EA. Peritoneal dialysis for older people: Overcoming the barriers. Kidney Int 2008; 73:S68-71.  Back to cited text no. 8
9.Dombros N, Dratwa M, Feriani M, et al. Euro-pean best practice guidelines for peritoneal dialysis. 5 Peritoneal dialysis solutions. Nephrol Dial Transplant 2005;20(Suppl 9):ix16-20.  Back to cited text no. 9
10.Frampton JE, Plosker GL. Icodextrin: a review of its use in peritoneal dialysis. Drugs 2003; 63:2079-105.  Back to cited text no. 10
11.Kim S, Oh J, Kim S, et al. Benefits of bio-compatible PD fluid for preservation of resi-dual renal function in incident CAPD patients: a 1-year study. Nephrol Dial Transplant 2009; 2:1-11.  Back to cited text no. 11
12.Stinghen AE, Barretti P, Pecoits-Filho R. Factors contributing to the differences in peri-tonitis rates between centers and regions. Perit Dial Int 2007;27(S2):S281-5.  Back to cited text no. 12
13.Little J, Irwin A, Marshall T, Rayner H, Smith S. Predicting a patient′s choice of dialysis mo-dality: experience in a United Kingdom renal department. Am J Kidney Dis 2001;37:981-6.  Back to cited text no. 13
14.Jager KJ, Korevaar JC, Dekker FW, Krediet RT, Boeschoten EW. The effect of contra-indications and patient preference on dialysis modality selection in ESRD patients in The Netherlands. Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD) Study Group. Am J Kidney Dis 2004;43:891-9.  Back to cited text no. 14
15.Rodd K, Wuerth D, Finkelstein FO. Progress and Barriers that Continue to Challenge the CKD Educational Process. Perit Dial Int 2006; 26(suppl 1):46A.  Back to cited text no. 15
16.Goovaerts T, Jadoul M, Goffin E. Influence of a Pre-Dialysis Education Programme (PDEP) on the mode of renal replacement therapy. Nephrol Dial Transpl 2005;20:1842-7.  Back to cited text no. 16
17.Rubin HR, Fink NE, Plantinga LC. Patient ratings of dialysis care with peritoneal dialysis vs. Hemodialysis. JAMA 2004;291:697-704.  Back to cited text no. 17
18.Juergensen E, Wuerth D, Juergensen PJ. Hemodialysis and peritoneal dialysis: patient′s assessment of their satisfaction with therapy and the impact of the therapy on their lives. Clin J Am Soc Nephrol 2006;1:1191-6.  Back to cited text no. 18
19.Ramos Sanchez A, Madonia C, Rascon-Pacheco RA. Improved patient/technique sur-vival and peritonitis rates in patients treated with automated peritoneal dialysis when com-pared to continuous ambulatory peritoneal dia-lysis in a Mexican PD center. Kidney Int 2008;73:S76-80.  Back to cited text no. 19
20.Saudi Centre for Organ Transplantation Annual Report 2008. www.scot.org.sa   Back to cited text no. 20
21.Venkataraman V, Nolph KD. Utilization of PD modalities: evolution. Semin Dial 2002;15: 380-4.  Back to cited text no. 21
22.Keshaviah P, Emerson PF, Vonesh EF, Brandes JC. Relationship between body size, fill volume, and mass transfer area coefficient in peritoneal dialysis. J Am Soc Nephrol 1994;4:1820-6.  Back to cited text no. 22
23.Badve SV, Hawley CM, Mcdonald SP, et al. Automated and continuous ambulatory peri-toneal dialysis have similar outcomes. Kidney Int 2008;73:480-8.  Back to cited text no. 23
24.Michels MW, Verduijn M, Boeschoten EW, Dekker FW, Krediet RT; for the NECOSAD Study Group. Similar survival on automated peritoneal dialysis and continuous ambulatory peritoneal dialysis in a large prospective cohort. Clin J Am Soc Nephrol 2009;4:943-9.  Back to cited text no. 24
25.Rodriguez-Carmona A, Perez FM, Garcia FT, et al. A comparative analysis on the incidence of peritonitis and exit-site infection in CAPD and automated peritoneal dialysis. Perit Dial Int 1999;19:253-8.  Back to cited text no. 25
26.Huang JW, Hung KY, Yen CJ, et al. Compa-rison of infectious complications in peritoneal dialysis patients using either a twin-bag system or automated peritoneal dialysis. Nephrol Dial Transplant 2001;16:604-7.  Back to cited text no. 26
27.Davison SN, Jhangri GS, Jindal K, Pannu N. Comparison of volume overload with cycler-assisted versus continuous ambulatory perito-neal dialysis. Clin J Am Soc Nephrol 2009; 4:1044-50.  Back to cited text no. 27
28.Mujais S, Nolph K, Gokal R, et al. Evaluation and management of ultrafiltration problems in peritoneal dialysis. International Society of peritoneal Dialysis AdHoc Committee on Ultrafiltration Management in Peritoneal Dialysis. Perit Dial Int 2000;20(suppl 4):S5-21.  Back to cited text no. 28
29.Blake PG. Advantages and disadvantages of automated peritoneal dialysis compared to continuous ambulatory peritoneal dialysis. Perit Dial Int 1999;19(Suppl 2):S11-4.  Back to cited text no. 29
30.De Wit GA, Merkus MP, Krediet RT, et al. A comparison of quality of life of patients on automated and continuous ambulatory perito-neal dialysis. Perit Dial Int 2001;21:306-12.  Back to cited text no. 30
31.Brown EA, Davies SJ, Heimburger O, et al. Adequacy targets can be met in anuric patients by automated peritoneal dialysis: baseline data from the EAPOS. Perit Dial Int 2001;21:S133-7.  Back to cited text no. 31
32.Wang AY. The heart of peritoneal dialysis: residual renal function. Perit Dial Int 2007; 27:116-24.  Back to cited text no. 32
33.Cendoroglo M, Draibe S, Silva A, et al. Incidence and risk factors for hepatitis B virus and hepatitis C virus infection among hemo-dialysis and CAPD patients: evidence for en-vironmental transmission. Nephrol Dial Trans-plant 1995;10:240-6.  Back to cited text no. 33
34.Pereira B, Levey A. Hepatitis C virus infection in dialysis and renal transplantation. Kidney Int 1997;51:981-99.  Back to cited text no. 34
35.Coles GA, Williams JD. What is the place of peritoneal dialysis in the integrated treatment of renal failure? Kidney Int 1998;54:2234-40.  Back to cited text no. 35
36.Guo A, Mujais S. Patient and technique survival on peritoneal dialysis in the United States: Evaluation in large incident cohorts. Kidney Int 2003;64:S3-12.  Back to cited text no. 36
37.UK Renal Registry. The seventh UK Renal Registry Report, 2004. Chapter 4: all patients receiving renal replacement therapy in the United Kingdom in 2003, Bristol, 2004.  Back to cited text no. 37
38.Rao R, Ansell D, Gilg JA, Davies SJ, Lamb EJ, Tomson CR. Effect of change in renal re-placement therapy modality on laboratory va-riables: a cohort study from the UK Renal Registry. Nephrol Dial Transplant 2009;24(9): 2877-82.  Back to cited text no. 38
39.Van Biesen W, Dequidt C, Vijt D, Vanholder R, Lameire N. Analysis of the reasons for transfers between haemodialysis to peritoneal dialysis and their effect on survivals. Adv Perit Dial 1998;14:90-4.  Back to cited text no. 39
40.Lobbedez T, Crand A, Le Roy F, et al. Transfer from chronic hemodialysis to perito-neal dialysis. Nephrol Ther 2005;1:38-43.  Back to cited text no. 40
41.Zhang X, Han F, He Q, et al. Outcomes and risk factors for mortality after transfer from hemodialysis to peritoneal dialysis in uremic patients. Perit Dial Int 2008;28:313-4.  Back to cited text no. 41
42.Wu IW, Wang SY, Hsu KH, et al. Multi-disciplinary predialysis education decreases the incidence of dialysis and reduces mortality-a controlled cohort study based on the NKF/ DOQI guidelines. Nephrol Dial Transplant 2009;2:1-8.  Back to cited text no. 42
43.Bernardini J, Price V, Figueiredo A. Peritoneal dialysis patient training, 2006 (ISPD guide-lines/recommendations). Perit Dial Int 2006; 26:625-32.  Back to cited text no. 43
44.Hamad A, Nassri MS, Durham JB, Still P, Goodwin M, Poole R. Building a successful peritoneal dialysis program: a rural center′s experience. Perit Dial Int 2007;27:S15.  Back to cited text no. 44
45.DeHaan BD. Why peritoneal dialysis should be the first treatment option. Dial Transplant 2003;32:160-4.  Back to cited text no. 45
46.Abu-Alfa AK. The ADEMEX Study: Expan-ding the boundries of peritoneal dialysis ade-quacy beyond small solute clearances. Dialysis Transpl 2003;32:115-24.  Back to cited text no. 46
47.Sola L, Noboa O, Fleitas G, Laborda R, Quintero V. Transfer to peritoneal dialysis due to vascular access complications. Perit Dial Int 2007;27:S18.  Back to cited text no. 47
48.Van Biesen W, Veys N, Lameire N, Vanholder R. Why less success of the peritoneal dialysis programmes in Europe? Nephrol Dial Transplant 2008;23:1478-81.  Back to cited text no. 48
49.Ignace S, Fouque D, Arkouche W, Steghens JP, Guebre-Egzisbher F. Preserved residual renal function is associated with lower oxi-dative stress in peritoneal dialysis patients. Nephrol Dial Transplant 2009;24:1685-9.  Back to cited text no. 49
50.Bender FH, Bernardini J, Piraino B. Prevention of infectious complications in peritoneal dialysis: best demonstrated practices. Kidney Int 2006;70:S44-54.  Back to cited text no. 50
51.Bouvier N, Durand PY, Testa A, et al. Regional discrepancies in peritoneal dialysis utilization in France: the role of the nephro-logist′s opinion about peritoneal dialysis. Nephrol Dial Transplant 2009;24(4):1293-7.  Back to cited text no. 51

Correspondence Address:
Ayman Karkar
Department of Nephrology, Kanoo Kidney Centre, P.O. Box 11825, Dammam 31463
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

PMID: 21196611

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