Peritoneal dialysis therapy is a viable dialysis option for anuric patients: A retrospective cohort study

IntroductionCompared to conventional, maintenance hemodialysis, peritoneal dialysis (PD) better preserves residual kidney function (RKF) in patients with kidney failure. However, few studies have investigated long-term prognosis of PD patients with anuria. This study aimed to investigate the long-term outcomes of anuric PD patients.MethodsIn this retrospective single-center cohort study, we included patients who received continuous ambulatory peritoneal dialysis (CAPD) and developed anuria between 2006 to 2020. The primary outcome was all-cause mortality. Secondary outcomes included technique survival and cardiovascular (CV) mortality. Cox proportional hazards regression, competing risk analysis, and subgroup analyses were performed to identify prognostic factors.ResultsA total of 615 anuric CAPD patients were included in the study, with a mean age of 47.8 ± 14.8 years at the onset of anuria. Prior to anuria onset, patients had received PD for a mean of 30.5 ± 23.0 months; following anuria onset, the median follow-up time was 40.3 months (interquartile range, 23.8-68.3). The 5- and 10-year patient survival rates following anuria onset were 68.2% and 37.1%, respectively, with corresponding technique survival rates of 75.4% and 50.6%. Cox regression analysis identified older age (cause-specific hazard ratio (cHR) 1.05; 95% confidence interval (CI) 1.04-1.06), lower serum albumin (cHR 0.97; 95% CI 0.94-1.00), diabetes (cHR 1.74; 95% CI 1.27-2.39), and cardiovascular disease (cHR 1.64; 95% CI 1.15-2.34) as independent predictors of all-cause mortality. Competing risk analysis revealed that higher glucose exposure (per 30 g/day increase) (subdistribution HR (sHR) 1.24; 95% CI 1.06-1.46) and peritonitis episodes (sHR 1.82; 95% CI 1.31-2.55) were independently associated with technique survival. Subgroup analyses revealed that the adverse prognostic effect of diabetes on all-cause mortality was more pronounced in patients aged <65 years than in those aged ≥65 years (P for interaction = 0.019).ConclusionsThis study demonstrates that PD patients who developed anuria can still achieve favorable long-term clinical outcomes, with a 5-year patient survival exceeding 68% and technique survival rates above 75%. These findings support the continued use of PD as a viable dialysis modality even after complete loss of RKF.