Peritoneal Dialysis Technique Survival: A Cohort Study.
In a large U.S. cohort, patients who started dialysis directly on peritoneal dialysis stayed on it longer than those who switched to it from haemodialysis, and peritonitis, low albumin and inadequate clearance were the main reasons people transferred to haemodialysis.
Background
Peritoneal dialysis (PD) offers quality-of-life and other advantages over in-centre haemodialysis (HD), but a substantial share of patients transfer to HD before realising those benefits. The reasons for transfer have been incompletely understood.
Study design
Retrospective cohort of 5,224 adults who initiated PD at a Dialysis Clinic, Inc. facility between 2010 and 2019, categorised as PD-first (3,174), PD-early (942, transitioned from HD within 90 days) or PD-late (1,108, beyond 90 days). The outcome was a modality switch from PD to HD sustained more than 90 days, analysed with multivariable Fine-Gray competing-risk models.
Key findings
Overall, 1,472 patients (28%) transferred to HD. Compared with PD-first patients, PD-early and PD-late patients had a higher transfer risk in the first 9 months (adjusted HR 1.51 [95% CI 1.17-1.96] and 2.41 [1.94-3.00], respectively). More peritonitis episodes, fewer home visits, lower serum albumin, lower residual kidney function and lower weekly Kt/V were additional risk factors.
Clinical implications
Initiating dialysis directly with PD is associated with greater technique survival. Because peritonitis, hypoalbuminaemia and inadequate clearance are potentially modifiable, programmes that reduce infection and support adequacy and home visits may keep more patients on PD longer.
Category
Research
Source
American Journal of Kidney Diseases
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