Kidney Week

Abstract: TH-PO371

Regional Variation in Peritoneal Dialysis (PD) Time on Therapy (ToT): Results from the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS)

Session Information

• Dialysis: Peritoneal Dialysis - I
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 703 Dialysis: Peritoneal Dialysis

Authors

• Perl, Jeffrey, St. Michael's Hospital, Toronto, Ontario, Canada

Jeffrey Perl,

• Zhao, Junhui, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Junhui Zhao,

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

Bruce M. Robinson,

• Davies, Simon J., Keele University, Stoke-on-Trent, United Kingdom

Simon J. Davies,

• Kawanishi, Hideki, Tsuchiya General Hospital, Hiroshima, Japan

Hideki Kawanishi,

• Johnson, David W., Princess Alexandra Hospital, Brisbane, Queensland, Australia

David W. Johnson,

• Sloand, James A., JAS Renaissance, Chicago, Illinois, United States

James A. Sloand,

• Sanabria, Mauricio, RTS Baxter, Bogota, Colombia

Mauricio Sanabria,

• Kanjanabuch, Talerngsak, Chulalongkorn University, Bangkok, Thailand

Talerngsak Kanjanabuch,

• Kim, Yong-Lim, Kyungpook National University Hospital, Daegu, Korea (the Republic of)

Yong-Lim Kim,

• Shen, Jenny I., LaBiomed at Harbor-UCLA, Torrance, California, United States

Jenny I. Shen,

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

Ronald L. Pisoni,

Background

Transition to hemodialysis (HD) carries significant morbidity and reduced quality of life for PD patients. PDOPPS seeks to identify practices aimed at meaningfully prolonging technique survival on PD. Here we describe PD discontinuation and death rate in PDOPPS.

Methods

PDOPPS is a prospective cohort study of randomly selected patients across national samples of PD facilities from Australia/New Zealand (A/NZ), Canada, Japan, Thailand, the UK, and the US. The study population included 20532 patients who were followed until death (on PD) or permanent switch to HD, based on initial designation as a permanent transfer or a temporary transfer with no return at 12 weeks. ToT (from PD start to death or permanent transfer to HD) and hazard ratios (HR) were estimated using Cox models based on PD vintage at study entry (age, sex, and diabetes adjusted).

Results

16% of patients transferred to HD and 13% of patients died. Median (IQR) ToT was 3.0 (1.3-5.7) years, ranging from 2.3 (1.1-4.4) in the UK to 4.5 (2.3-9.0) in Japan. Relative to the US, HR (95% CI) for transfer to HD were similar in Japan, Canada, and A/NZ, lower in Thailand (0.5, 0.3-0.7), and higher in the UK (1.5, 1.0-2.0). Compared to the US, HR for death was lower in Japan (0.4, 0.3-0.5), higher in Thailand (1.9, 1.4-2.5), and similar in A/NZ, Canada, and the UK. Variation in death, and transfer to HD (was seen across facilities [figure].

Conclusion

In PDOPPS, rates of permanent transfer to HD, and death vary significantly by country and facility. Future work will identify reasons for variation in PD outcomes, and identify practices to reduce the risk of PD attrition.

Funding

• Commercial Support – The DOPPS Program is supported by Amgen, Kyowa Hakko Kirin, Baxter Healthcare. Additional support for specific projects and countries is provided by AstraZeneca, European Renal Association-European Dialysis & Transplant Association (ERA-EDTA), Fresenius Medical Care Asia-Pacific Ltd, Fresenius Medical Care Canada Ltd, German Society of Nephrology (DGfN), Janssen, Japanese Society for Peritoneal Dialysis (JSPD), Keryx, Kidney Care UK, MEDICE Arzneimittel Pütter GmbH & Co KG, Proteon, and Vifor Fresenius Medical Care Renal Pharma. Public funding and support is provided for specific DOPPS projects, ancillary studies, or affiliated research projects by National Health & Medical Research Council (NHMRC) in Australia, Cancer Care Ontario (CCO) through the Ontario Renal Network (ORN) in Canada, French National Institute of Health and Medical Research (INSERM) in France, Thailand Research Foundation (TRF), Chulalongkorn University Matching Fund, King Chulalongkorn Memorial Hospital Matching Fund, and the National Research Council of Thailand (NRCT) in Thailand, National Institute for Health Research (NIHR) via the Comprehensive Clinical Research Network (CCRN) in the United Kingdom, and National Institutes of Health (NIH) in the US. All support is provided without restrictions on publications. All grants are made to Arbor Research Collaborative for Health and not to Dr. Perl directly.