Poor Outcome of Peritoneal Dialysis during Scleroderma Renal Crisis in Scleroderma Patients
Yada Siriphannon MD1, Chingching Foocharoen MD1, Tanapon Ussanawarong MD1, Sirirat Reungjui MD1, Ajanee Mahakkanukrauh MD1, Siraphop Suwannaroj MD1, Ratanavadee Nanagara MD1
Affiliation : 1 Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Objective : Peritoneal dialysis [PD] was a treatment but renal crisis among systemic sclerosis [SSc] patients with Scleroderma
renal crisis [SRC] are uncertain. Our objectives were to determine (a) whether peritoneal dialysis [PD] was stopped at 18
months; (b) the clinical predictors thereof and (c) the proportion of patients who needed to change dialysis modality.
Materials and Methods : A historical cohort study among scleroderma renal crisis [SRC] patients followed-up at Srinagarind
Hospital, Thailand, between January 1999 and December 2014.
Results : 42 SRC patients were enrolled (30 females): 90% with the diffuse cutaneous SSc subset: mean age at SRC diagnosis
57.3+8.5 years. All were given Captopril, Enalapril, or Ramipril; 5 had renal recovery without dialysis and 22 (52.4%)
underwent either hemodialysis [HD] (16; 72.7%) or PD (6; 27.3%). Overall 13 cases underwent continuous ambulatory
peritoneal dialysis [CAPD]; 6 chose CAPD as the initial mode of dialysis and 7 changed from HD. One-third in the PD group
changed mode due to peritoneal infection and/or fluid leakage. None of the PD patients were free of peritoneal dialysis within
18 months of diagnosis. Most (92.3%) died within 18 months after starting dialysis and most from SRC (75%).
Conclusion : None of the PD SRC patients were free from dialysis within 18 months of starting dialysis. One-third needed
to change mode of dialysis due to complications. A minority had renal recovery without any dialysis.
Keywords : Systemic sclerosis, Scleroderma, Observational study, Peritoneal dialysis, Renal crisis
