Searching for the reasons for drop-out from peritoneal dialysis: a nationwide survey in Japan

We wanted to clarify, in a large population, the reasons that peritoneal dialysis (PD) was interrupted and to propose appropriate strategies that might prolong the use of PD as a renal replacement therapy.

We enrolled 5 391 patients from 439 centers into the study. Each center used a worksheet to report details about patients who either transferred to hemodialysis (HD) or died on continuous ambulatory peritoneal dialysis (CAPD) over a 6-month period from 1 April 2000, to 30 September 2000.

We collected 252 drop-out cases from 141 centers. Of the 252 cases, 170 (67.5%) involved transfer to HD, and 82 (32.5%) involved death while on PD. Primary renal diseases were chronic nephritis (CN: 51.6%), diabetic nephropathy (DM: 26.6%), nephrosclerosis (4%), and unspecified or other condition (15.8%). Mean duration on PD in drop-out cases was 4.47 years. The age of patients at transfer to HD was younger (53.7 years) than the age of patients at death on PD (65.2 years). Patients with CN remained on PD significantly longer than did patients with DM (5 years vs 2.4 years). The three main reasons for PD discontinuation were overhydration because of ultrafiltration failure (UFF) or poor compliance with salt and fluid restrictions (34.1%); peritonitis (30.1%); and preference of the physician, patient, or family (6.5%). The proportional share represented by those three major reasons varied with the number of years since PD initiation (from 1 year to more than 8 years). Patients who had been on PD for a longer time were more likely to drop out because of UFF and less likely to drop out because of peritonitis. The three major causes of death on CAPD were cerebrovascular accident (22%), ischemic heart disease (14.6%), and sudden death (9.8%).

Approximately 10% of patients drop out from PD programs annually in Japan. To prolong PD treatment, new solutions that better preserve peritoneal function need to be developed, and patients and caregivers alike need to receive intensive education in preventing and treating peritonitis.