What is the effect of the assistance on the risk of transfer to HD after an unplanned peritoneal dialysis initiation? A cohort study with data from the RDPLF

BackgroundsUnplanned initiation of peritoneal dialysis (PD) is linked to higher risks of complications and transfer to hemodialysis (HD). This study evaluates whether assisted PD was associated with the risk of transitioning to hemodialysis, for the individuals experiencing unplanned PD initiation.MethodsThis retrospective study analyzed data from the French Language Peritoneal Dialysis Registry (RDPLF), including 1009 patients with unplanned PD initiation, defined as a period of <30 days on HD before PD initiation, between January 1, 2002, and December 31, 2018. We compared assisted PD (nurse/family-assisted) versus self-care PD using cause-specific analyses. Time-dependent coefficient Cox regression addressed non-proportional hazards. Mediation analysis was conducted to explore the direct and indirect effects of assisted PD on the risk of transfer to HD, considering early peritonitis as a mediator.ResultsIn unplanned starters, Assisted PD was associated with an increased early risk of transfer to HD within the first six months (cs-HR 2.00, 95% CI 1.30-3.30), but a reduced risk thereafter (cs-HR 0.70, 95% CI 0.50-0.90). Patients on assisted PD had a higher risk of death (cs-HR 2.39, 95% CI 1.77-3.24) and a lower likelihood of transplantation (cs-HR 0.23, 95% CI 0.12-0.42). Mediation analysis revealed no significant indirect effect of assisted PD on the risk of transfer to HD via early peritonitis.ConclusionUnplanned PD initiation presents significant early risks, with assisted PD showing delayed protective effects after six months. Targeted early support (psychological and social) and further research are crucial to optimize outcomes for this patient group.