Abstract: TH-OR088

Survival and Kidney Transplant Incidence on Home versus In-Center Hemodialysis, Following Peritoneal Dialysis Technique Failure

Session Information

  • Peritoneal Dialysis
    November 02, 2017 | Location: Room 290, Morial Convention Center
    Abstract Time: 04:30 PM - 04:42 PM

Category: Dialysis

  • 608 Peritoneal Dialysis

Authors

  • Kansal, Sheru, None, Cleveland, Ohio, United States
  • Morfin, Jose A., University of California Davis, El Dorado Hills, California, United States
  • Weinhandl, Eric D., NxStage Medical, Inc., Victoria, Minnesota, United States
Background

Peritoneal dialysis (PD) technique failure is often accompanied by complications that increase risks of hospitalization and death. Planned transition to hemodialysis may improve outcomes. Transitioning patients from PD to home hemodialysis (HHD) may improve continuity of lifestyle and facilitate delivery of more frequent treatment. However, data about transfer from PD to HHD are sparse.

Methods

We analyzed United States Renal Data System (USRDS) data from to compare incidence of death and kidney transplant in patients that transferred from PD to HHD in 2006-2012 and matched patients that transferred from PD to in-center hemodialysis (IHD). We used propensity score matching, with scores as a function of demographics and comorbidity; for each patient that transferred from PD to HHD, we selected 3 matched patients that transferred from PD to IHD. We used Fine-Gray regression to estimate intention-to-treat hazard ratios (HRs) of death and transplant for HHD versus IHD, in aggregate and stratified by insurance status (non-Medicare, Medicare).

Results

We identified 521 patients who transferred to HHD and 32,871 patients who transferred to IHD. Before matching, mean hospitalized days during the 6-month interval surrounding PD technique failure were 9.1 in Medicare patients who transferred to HHD and 18.5 in Medicare patients who transferred to IHD. Survival in HHD patients was 89.1% at 1 year and 80.5% at 2 years. The HR of death for HHD versus matched IHD patients was 0.76 (95% confidence interval, 0.65-0.90). In subsets of non-Medicare and Medicare patients, corresponding HRs were 0.57 (0.43-0.75) and 0.92 (0.75-1.13), respectively. In Medicare patients, lower hazard of death with HHD was evident only after 2 years of follow-up. Kidney transplant incidence in HHD patients was 10.6% at 1 year and 21.0% at 2 years. The HR of transplant for HHD versus matched IHD patients was 1.36 (1.14-1.61).

Conclusion

Transfer to HHD after PD technique failure was rare, but associated with lower risk of death and higher incidence of transplant than transfer to IHD. Heterogeneity in relative risks by insurance status suggests uncertainty about the magnitude of benefit. Still, the high hospitalization rate that typifies the transfer from PD to IHD suggests that clinical outcomes after PD technique failure can be improved.