Peritoneal Dialysis Technique Survival: A Cohort Study.

Area of Science:

• Nephrology
• Renal Replacement Therapy
• Dialysis Modalities

Background:

• Peritoneal dialysis (PD) offers advantages over hemodialysis (HD) but a significant number of patients transfer to HD prematurely.
• Understanding factors influencing PD technique survival is crucial for optimizing patient care.

Purpose of the Study:

• To evaluate the association of clinical factors, including prior hemodialysis (HD) treatment, with peritoneal dialysis (PD) technique survival.
• To identify risk factors for transfer from PD to HD.

Main Methods:

• Retrospective cohort study of 5,224 adult patients initiating PD between 2010 and 2019.
• Analysis categorized PD initiation timing: PD-first, PD-early (HD to PD within 90 days), and PD-late (HD to PD after 90 days).
• Multivariable Fine-Gray models with competing risks and time-varying covariates were used.

Main Results:

• Patients initiating PD later (PD-early and PD-late) had a significantly higher risk of transferring to HD compared to PD-first patients.
• Risk factors for PD-to-HD transfer included more peritonitis episodes, fewer home visits, lower serum albumin, reduced residual kidney function, and lower weekly Kt/V.
• 28% of patients (1,472) transferred from PD to HD during the study period.

Conclusions:

• Initiating dialysis with PD is associated with improved PD technique survival.
• Peritonitis, lower serum albumin, and lower peritoneal clearance (Kt/V) are modifiable risk factors for PD-to-HD transfer.
• Further research is needed to address missing data on dialysis adequacy and residual kidney function.