Prevalence and Risk Factors of Technique Failure in Peritoneal Dialysis of Iranian Children and Adolescents

Authors

1 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

2 Pediatric Chronic Kidney Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran AND Department of Pediatric Nephrology, Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.

3 Community Medicine, College of Medicine, University of Sulaimani. Sulaimani, Iraq.

4 Community Health Department, Technical College of Health, Sulaimani Polytechnic University, Sulaimani, Iraq.

5 Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.

6 Nephrology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

7 Department of Public Health, Asadabad School of Medical Sciences, Asadabad, Iran.

8 Department of Anthropology, Faculty of Social Sciences, Islamic Azad University Central Tehran Branch, Iran.

9 Pediatric Chronic Kidney Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran AND Pediatric Department, Valiasr Hospital, Tehran University of Medical Sciences, Tehran, Iran.

10 Physiology Research Center, Faculty of Medicne, Iran University of Medical Sciences, Tehran, Iran.

Abstract

Background: Statistics have shown that the rate of technical failure in peritoneal dialysis (PD) is greater than hemodialysis. In this regard, the present study is aimed to determine the prevalence and risks factors of technique failure of PD in Iranian children using the country’s computerized PD data registry system.
Materials and Methods: Data of 405 PD patients younger than 20 years old were extracted from Iranian PD registry. The joint models of longitudinal and time-to-event data were used to assess independent risk factors of PD technique failure.
Results: PD technique failure occurred in 17.3% of the patients. 1 ng/ml increase in the baseline level of ferritin and 1 mmHg increase in the baseline systolic blood pressure will result in 0.11% (Hazard Ratio [HR]=1.0011; p=0.001), and 1.25% (HR=1.0125; p=0.046) increase in the risk of PD technique failure, respectively. In addition, 1 g/dl decrease in the baseline hemoglobin will cause a 16.25% increase in the risk of PD technique failure (HR=0.8602; p=0.026). Finally, 1 mg/l decrease in the blood urea nitrogen over time after starting PD will result in 1.75% increase in the risk of PD technique failure (HR=0.9829; p=0.006).
Conclusion: The findings from this study showed that an increase in ferritin as well as systolic blood pressure at the beginning of PD increase the risk of technique failure. Furthermore, an increase in the hemoglobin level at the beginning of PD as well as an increase in the blood urea nitrogen over time after starting PD have protective impacts on pediatric PD technique failure.

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