－S 687 －
― ♣F-245 ―
Technique and patient survival in peritoneal dialysis ; A single center experience
Division of Nephrology, Department of Internal medicine, Kyungpook National University, School of Medicine and Clinical Research Center for ESRD, Daegu, Korea
*Hye-Jin Seo, M.D., Seung-Hyea Hyun, M.D., Gun-Hyun Kim, M.D., Joo-Hyun Chun, M.D., Ji-Young Choi, M.D., Ji-Hyung Cho, M.D., Chan-Duck Kim, M.D., Sun-Hee Park, M.D., Yong-Lim Kim, M.D.,
Background: Continuous ambulatory peritoneal dialysis (CAPD) is an established treatment modality in patients with end-stage renal disease (ESRD). As connection system improves, greater technique survival of PD patients was reported in the past two decades. We investigated the outcome of CAPD over a period of 15 years at our institution. Methods: Patients who initiated PD since 1994 were retrospectively recruited.
Patients with age of under 15 years at initiation of CAPD, less than 1 month of follow-up and missing data were excluded. Technique survival rate and cause of technique failure as well as patient survival and cause of death were evaluated. Results: A total of 608 CAPD patients (342 males (56.3%)) were analyzed using Kaplan-Meier method and log-rank test. Mean age at the start of CAPD was 50.7±15.1 years, and mean PD duration 50.2±41.5 months. The most common primary renal disease was diabetes (39.6%), followed by chronic glomerulonephritis (37.2%) and hypertension (13.0%). The 1-,3-,5- and 10-year death-censored technique survival rates were 97.3%,91.7%, 82.8% and 67.5% respectively.
Sex or diabetic status did not affect technique survival rate. Patients with age of less than 60 years showed better technique survival compared to older patients at the start of CAPD (p=0.005).The main cause of technique failure was peritonitis (71.6%), followed by mechanical malfunction (9.5%), ultrafiltration failure (7.4%), and inadequate dialysis (6.3%). The 1-,3-,5- and 10-year patient survival rates were 92.8%, 74.2%, 60.3% and 34.2% respectively. The analysis revealed better patient survival rates in non-diabetic (p<0.001), female (p<0.05) and younger (< 60 years old) (p<0.001). The major causes of death were cardiac (25.0%), infectious (17.9%) and cerebrovascular disease(15.1%).
Conclusion: Complicated cases of peritonitis are still the most common cause of PD technique failure and diabetes has a higher mortality rate.
To reduce technique failure and mortality in high risk groups, more intensive management should be needed.
― F-246 ―
Delayed life-threatening hemorrhage after percutaneous renal biopsy that successfully treated with a percutaneous angiographic intervention
Department of nephrology, Radiology1, Daegu-Fatima Hospital, Daegu, Korea Dong-Hyun Kim*, Sung-Ho Kim, Duck-Hyun Lee, Dae-Myung Oh, Ye-Su Jang, Hee-Jin Kim1
Although percutaneous renal biopsy (PRB) is relatively safe, life-threatening complications may occur. Most of the complications occur within a day and 24 hrs of observation after PRB is considered optimal. However, we experienced a case of life-threatening bleeding several days after PRB that successfully treated with a percutaneous arterial embolization. Case: A 45-yr-old male presented with dyspnea for 5-mo. He had hypertension for 2 yrs. His BP was high (190/110 mmHg). Laboratory test results were as follows: Hb 12.9 g/dl, Hct 38.1 %, platelet 202,000/uL, BUN 36.0 mg/dl, creatinine 2.6 mg/dL, PT 13.5 sec, INR 1.17, aPTT 25.6 sec, urine protein (++), and 24-hr proteinuria 2.58 g/day. Echocardiography revealed hypertensive cardiomyopathy with EF 36%. Ultrasonography (US) revealed normal size but echogenic kidneys. After moderate control of BP (to 160-130/ 90-80 mmHg), US-guided PRB with 18-gauge biopsy needle (Acecut automatic biopsy system, TSK laboratory, Japan) done and 2 kidney tissues taken. Immediately after PRB, vital signs (VS) were stable and no gross hematuria or symptoms developed despite of slightly dropped Hb (13.2 to 11.9 g/dL). Sixty-six hours after PRB, sudden left flank pain and hypotension (100/60 mmHg) developed. CT scan showed huge perirenal hematoma. After packed RBC transfusion and bed rest, his VS became stable and no further evidence of ongoing hemorrhage noted. However, 7 days after PRB, left flank pain with hypotension (80/60 mmHg) recurred. CT scan showed increased hematoma. Selective renal angiogram showed contrast leakage at left inferior segmental artery. Selective arterial embolization with two 2cmx2mm microcoil and gelform undertaken. After the intervention, the VS were stable and no further evidence of ongoing bleeding noted. Discussion: Although controversy remains, factors such as poorly controlled BP, renal insufficiency, degree of proteinuria, bleeding tendency (prolonged BT, PT, aPTT), Hb level and biopsy needle size had been suggested as a risk factor of complication after PRB. Although up to 24 hr is considered as optimal observation time after PRB, more prolonged observation or bed rest may be needed for those patients with risk factors.
