Peritoneal dialysis in a Moroccan center: Prevalence and complications
Keywords:Peritoneal dialysis, prevalence, outcome, complications, Morocco
Introduction: Peritoneal dialysis (PD) is as effective as hemodialysis and often provides a better quality of life for patients. Despite this, the replacement therapy remains little established in our country with a prevalence of less than 1% of patients with end-stage renal disease. The objective of this work is to report the development and complications of PD in our center.
Patients and methods: This is a retrospective study including all patients on PD between October 2008 and March 2019. We noted their demographic and clinical data at their initiation in peritoneal dialysis and we followed their evolution to discuss infectious and mechanical complications as well as the causes of PD exit.
Results: During the study period, 456 patients were admitted for end-stage renal disease. Among these patients, only 28 (6.1%) were put on PD including two diabetics. Their average age was 37.7 years with a sex ratio of 0.8. The average body surface area was 1.59 m² with an average residual renal function of 6.05 ml / min. PD was chosen as the first intention in 20 patients while 8 patients were on hemodialysis. The evolution was marked by a median survival of the technique of 18.5 months characterized by 8 episodes of peritonitis in 4 patients corresponding to a rate of 1 episode over 56 months. Regarding mechanical complications, we noted 9 omentum aspirations, 1 leak in one case and 1 umbilical hernia requiring surgical recovery in a patient. Out of 28 patients, 17 discharges were identified; 10 patients (67%) were transferred to hemodialysis, 4 died and only 3 patients (18%) were transplanted. The final transfer to hemodialysis was related to mechanical complications in 5 cases, loss of ultrafiltration in one case, repeated hydro-sodium overload in one case, peritonitis in one case and social reasons in two cases.
Conclusion: PD is an effective technique which preserves residual renal function and quality of life but its prevalence remains low in the order of 6% of patients treated for end-stage renal disease. The complications are dominated in our context by the mechanical complications main cause of final transfer in hemodialysis.
P Kam-Tao Li, C Chun Szeto , B Piraino and al. ISPD peritonitis recommendations: 2016 update on prevention and treatment. Peritoneal Dialysis International, Vol. 36, pp. 481–508
C Chun Szeto, P Kam-Tao Li, David W. Johnson an al. ISPD Catheter-Related Infection Recommendations: 2017 Update. Peritoneal Dialysis International, Vol. 37, pp. 141–154
Ryckelynck JP, Lobbedez T, Ficheux M, Bonnamy C, El Haggan W, Henri P, et al. Actualités en dialyse péritonéale. Presse Med 2007;36:1823–8.
Per Ivarsen and Johan. V Povlsen. Can peritoneal dialysis be applied for unplanned initiation of chronic dialysis? . Nephrol Dial Transplant 2014 Dec;29(12):220-6.
Alan Pan, BS1, Mun J. Poi, MD1, Jesus Matos, MD , Long-Term Outcomes of Single-Port Laparoscopic Placement of Peritoneal Dialysis Catheter Vascular and Endovascular Surgery 2016, Vol. 50(5) 343-348
S Grenêche, A D’Andon, C Jacquelinet. Choosing between peritoneal dialysis and haemodialysis: a critical appraisal of the literature. Néphrologie et thérapeutique 2005; 1 (4) : 213-220.
Habib A, et al. Facteurs influencant le choix de la dialyse peritoneale : le point de vue des patients et des nephrologues. Nephrologie & thérapeutique 13 (2017) 93-102
D Zaïd, H Dkhissi, L Benamar, : Recommandations de Bonnes Pratiques Médicales : Insuffisance Rénale Chronique Terminale, ALD 17 (Arrêté Ministériel) Mars 2013.
S. Beji 1 , A.O. Ben1, M. Krid2, R. Kheder2, H. Jebali Comparaison de l’évolution entre la dialyse péritonéale automatisée (DPA) et la dialyse péritonéale continue ambulatoire (DPCA) Abstracts / Néphrologie & Thérapeutique 12 (2016) 288–332
Murat Hayri S, Aysun A, Aydin U¨ , Bulent T, Oktay O, Cengiz U. Patient and technique survival and factors affecting mortality on peritoneal dialysis in Turkey: 12 years’ experience in a single Center. Perit Dial Int 2008;28: 238–45.
Gokal R, et al. Peritoneal Dialysis in the 21st Century: An Analysis of Current Problems and Future Developments. J Am Soc Nephrol. 2002;13:S104–116.
Marshall J, Jennings P, Scott A, Fluck RJ, Macintyre CW. Glycemic control in diabetic CAPD patients assessed by continuous glucose monitoring system (CGMS). Kidney Int 2003; 64:146–8.
Snyder JJ, Foley RN, Gilbertson DT, Vonesh EF, Collins AJ. Hemoglobin levels and erythropoietin doses in hemodialysis and peritoneal dialysis patients in the United States. J Am Soc Nephrol 2004;15(1):174–9.
Belkacem Issad a, Pierre-Yves Durand b, Pascale Siohan Focusing on peritoneal dialysis adequacy Elsevier Masson Nephrologie & Therapeutique 9 (2013) 416–425
M.el Koti DIALYSE PERITONEALE : techniques d’implantation du catheter, indications, complications et prise en charge : A propos de 19 cas, thèse n°277-08
García-Cruz E1, Vera-Rivera M, Corral Molina JM, Mallafré-Sala JM, Alcaraz A. [Laparoscopic placement of peritoneal dialysis catheter: description and results of a two-port technique] . Nefrologia. 2010;30(3):354-9.
Jennifer L. Carpenter a,b, Sara C. Fallon a,b, Sarah J. Swartz Outcomes after peritoneal dialysis catheter placement, Elsevier Masson Journal of Pediatric Surgery 51 (2016) 730–733
Flanigan M, Gokal R. Peritoneal catheters and exit-site practices toward optimum peritoneal access: a review of current developments. Perit Dial Int 2005;25:132–9.
Recorbet, C. Béchade, T. Lobbedez Prevention of dialysis liquid infections in patients on peritoneal dialysis M. Journal des Antiinfectieux (2015) 17, 141—144
S. Beaudreuil, H. Hebibi, B. Charpentier, A. Durrbachr Severe infections in dialysis patients: Peritonitis and vascular access-related infections Elsevier Masson Réanimation (2008) 17, 233—241
Finkelstein ES, Jekel J, Troidle L, Gorban-Brennan N, Finkelstein FO, et al. Patterns of infection in patients maintained on long-term peritoneal dialysis therapy with multiple episodes of peritonitis. Am J Kidney Dis 2002;39:1278—86
A.T. Lemrabott, M. Faye, M.S. Baldé, M.M. Cissé. Écologie bactérienne des infections péritonéales dans une unité de dialyse péritonéale d’Afrique subsaharienne Abstracts / Néphrologie & Thérapeutique 12 (2016) 288–332
Chalem Y, Ryckelynck JP, Tuppin P, Verger C, Chauvé S, Glotz D. French Collaborative Group. Access to, and outcome of, renal transplantation according to treatment modality of end-stage renal disease in France. Kidney Int. 2005 Jun; 67(6):2448–53.
How to Cite
Copyright (c) 2020 Abdelaali Bahadi
This work is licensed under a Creative Commons Attribution 4.0 International License.