Kidney Week

Abstract: TH-PO845

Mortality after Switching from Peritoneal Dialysis to In-Center Hemodialysis: Trends in the United States Renal Data System from 1996-2013

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

Nidhi Sukul,

• Mukhopadhyay, Purna, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Purna Mukhopadhyay,

• Pearson, Jeffrey, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Jeffrey Pearson,

• Schaubel, Douglas E., University of Michigan, Ann Arbor, Michigan, United States

Douglas E. Schaubel,

• Turenne, Marc, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Marc Turenne,

• Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States

Rajiv Saran,

• Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Bruce M. Robinson,

• Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Ronald L. Pisoni,

Background

Switching from peritoneal dialysis (PD) to in-center hemodialysis (ICHD) is disruptive to patients’ care, and transitioning from PD to ICHD has been associated with higher mortality risk when transitions are unplanned. To understand how mortality rates after a switch from PD to ICHD have changed over time, we examined trends in the United States Renal Data System from 1996-2013.

Methods

Five annual cohorts of incident PD patients who initiated PD within 180 days of ESRD designation and switched from PD to ICHD for ≥1 day were followed for death events for up to 180 days after switch. This 180-day risk period was divided into six consecutive 30-day segments. Death and time at risk were determined in each time segment, censoring for transplantation, return to PD, recovery of renal function, or loss to follow-up. Death rates are expressed per 100 patient years (PY).

Results

In each cohort, mortality was highest in the first 30 days post-switch, thereafter gradually declining (Figure). Death rates during the first 30 day period following switch to ICHD were 42.4 and 31.2 deaths/100 PY for the 1996 and 2013 cohorts, and decreased to 27.1 and 23.2 deaths/100 PY for the 151-180 days post-switch period. The percentage of patients in the first 30-day risk set who died decreased from 3.4% to 2.2% from 1996 to 2013, and in the 151-180-day risk set decreased from 2.2% to 1.6%. The summary death rate (combining the six time periods) was 33.2 deaths/100 PY for 1996 and 22.6 deaths/100 PY for 2013.

Conclusion

The initial 30 days post-switch from PD to ICHD is a high risk period, though there is an extended period of elevated risk after transition. The lower mortality rate for more recent cohorts may reflect improved peri-transition care in more recent years. Next steps will include adjusted analyses, and defining patient and center-level predictors to help inform means to improve mortality rates during this high-risk period.

Funding

• NIDDK Support