Abstract: TH-PO836

Transitions from Peritoneal Dialysis (PD) to In-Center Hemodialysis or Death: Trends in the United States Renal Data System from 1996-2011

Session Information

  • Peritoneal Dialysis - I
    November 02, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 608 Peritoneal Dialysis

Authors

  • Sukul, Nidhi, University of Michigan, Ann Arbor, Michigan, United States
  • Mukhopadhyay, Purna, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Pearson, Jeffrey, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Schaubel, Douglas E., University of Michigan, Ann Arbor, Michigan, United States
  • Turenne, Marc, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States
  • Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
Background

Transitioning from PD to in-center hemodialysis (ICHD) is disruptive to care. To understand changes in rates of mortality and transition from PD to ICHD among incident PD patients, we examined trends in the US Renal Data System from 1996-2011.

Methods

Annual cohorts of incident PD patients were followed for up to 3 years (Fig.1) for the outcomes of death, transition to ICHD, or the combined outcome of the two. Time at risk (expressed per 100 patient years [PY]) was calculated as days from PD incidence until date of transplant, death, 30 days after switching to ICHD or home hemodialysis, recovery of renal function, loss to follow-up, discontinuation of dialysis, or end of follow-up. Kaplan-Meier curves for 5-year survival on PD, adjusted for age, sex, race, ethnicity, and primary cause of ESRD, are shown for 5 annual cohorts (Figure 2).

Results

Trends in transition rates per 100 PY from 1996-2011 were: 20.2 to 10.7 for death, 24.7 to 20.7 for ICHD, 44.9 to 31.3 for death/ICHD (Fig.1). The Kaplan-Meier curves demonstrate that 50% of patients died or transitioned to ICHD by 1.63, 1.72, 1.83, 2.02, and 2.18 PY for 1996, 2002, 2005, and 2009 (Fig.2).

Conclusion

While rates of mortality and transition to ICHD have both declined, this was greater among mortality rates. Overall longer PD survival seen in recent years could potentially be due to better PD education, treatment, and/or patient selection. Further investigation is needed to better understand patient- and center-level predictors of these outcomes to further extend survival time on PD and the experiences of patients selecting this modality.

Funding

  • NIDDK Support