Trends in peritoneal dialysis demographics, peritonitis and HD transfer in Australia from 2013-2022

BackgroundThe proportion of dialysis patients performing PD in Australia is decreasing over time.¹ Understanding the trends in population, the rates and causes of peritonitis and haemodialysis (HD) transfer over time is critical towards understanding this trend.MethodsStudy Design: Registry-based cohort study using Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry data. Inclusion criteria: All Australian patients starting PD older than 18 years, starting PD within 90 days of KRT entry from 1 January 2013 through 31 December 2022.AnalysisPeritonitis rates were analysed using Poisson regression, while time to first peritonitis and HD transfer were assessed using Cox Proportional Hazards and competing-risks regression models.ResultsThe demographic profile of PD patients has remained relatively stable. Peritonitis rates declined from 0.40 to 0.33 infections per patient-year between 2013 and 2022. Over time, peritonitis-associated HD transfer reduced, HR 0.96 [95% CI: 0.93-0.98], p < .001. Despite this, there was a deterioration in overall HD transfer, HR 1.03 [95% CI: 1.02-1.04] per year, p < .001 and worse adjusted non-infective HD transfer HR 1.02 [95% CI: 1.01-1.04] per year, p = .006.ConclusionPD utilisation in Australia has declined over the past decade, despite improvements in peritonitis rates and peritonitis-associated HD transfer. The demographic profile of PD patients has remained relatively stable, suggesting systemic rather than patient-level factors are driving these trends. The apparent disconnect between infection control improvements and overall HD transfer highlights the growing importance of non-infective contributors such as access, psychosocial factors, and clinical support.