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TRANSITION PERIOD CLINICAL TRAJECTORIES FOR PD VERSUS HD STARTERS

Dugan W Maddux1, Len A Usvyat2, Thomas Blanchard2

  • 1Medical Office, Fresenius Medical Care North America, Waltham, United States dugan.maddux@fmc-na.com.

Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis
|September 28, 2018
PubMed

Insights

Hemodialysis (HD) starters show a faster decline in kidney function before starting dialysis compared to peritoneal dialysis (PD) starters. After starting, clinical parameter trends diverge, potentially due to treatment differences.

Area of Science:

  • Nephrology
  • Renal Medicine
  • Chronic Kidney Disease Management

Background:

  • Peritoneal dialysis (PD) starters often have better outcomes than hemodialysis (HD) starters, possibly due to treatment variations or patient selection.
  • Previous research indicated that clinical parameter changes before and after dialysis initiation correlate with patient outcomes.
  • This study aimed to analyze these clinical parameter trajectories in both PD and HD starters.

Purpose of the Study:

  • To investigate and compare the clinical parameter trajectories in patients initiating peritoneal dialysis (PD) versus hemodialysis (HD).
  • To understand the differences in patient status leading up to and during the initial phase of dialysis treatment.
  • To provide insights for optimizing patient care and comparing outcomes between dialysis modalities.

Main Methods:

  • A retrospective observational study utilizing data from the Fresenius Medical Care-chronic kidney disease (CKD) Registry.
  • Analysis of data from January 2009 to March 2018, including 8,088 HD and 1,015 PD starters.
  • Examination of clinical parameter trends 12 months before and 12 months after the initiation of dialysis therapy.

Main Results:

  • Hemodialysis starters exhibited a steeper decline in estimated glomerular filtration rate (eGFR) slope (-0.64 vs -0.45 mL/min/1.73 m²/month) and higher eGFR at initiation (9.85 vs 7.84 mL/min/1.73 m²) compared to PD starters.
  • Significant differences in phosphorus and hemoglobin slopes were observed before dialysis initiation.
  • Post-dialysis start, HD starters showed increased albumin, while PD starters experienced decreased serum sodium and increased white blood cell counts.

Conclusions:

  • While HD and PD starters appear clinically similar a year before dialysis, HD starters have a more rapid pre-dialytic eGFR decline.
  • Comparing incident HD and PD outcomes necessitates consideration of pre-dialytic chronic kidney disease (CKD) eGFR trajectories.
  • Divergent trends in albumin, white blood cell count, sodium, and hemoglobin emerge in the first year post-dialysis, potentially linked to treatment modality.
Abstract

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