Abstract: TH-PO392
Trends in the Rate of Conversion from Peritoneal Dialysis to Hemodialysis
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
- Weinhandl, Eric D., NxStage Medical, Inc., Victoria, Minnesota, United States
- Kubisiak, Kristine, NxStage Medical, Inc., Victoria, Minnesota, United States
- Ray, Debabrata, NxStage Medical, Inc., Victoria, Minnesota, United States
- Collins, Allan J., NxStage Medical, Inc., Victoria, Minnesota, United States
Background
Conversion from peritoneal dialysis (PD) to hemodialysis (HD) is frequently necessitated by medical complications, including peritonitis and ultrafiltration failure. Conversion can be disruptive to the patient, as it usually involves a transition from dialysis in the home to dialysis in a facility and may require placement of a permanent vascular access. In addition, high rates of conversion impose stress on dialysis providers, as high rates necessitate additional training in order to maintain program size. We assessed rates of conversion from PD to HD among US incident patients in 2006-2015.
Methods
We analyzed data from the United States Renal Data System. For each calendar year from 2006 to 2015, we identified all patients that initiated PD within 3 months after dialysis initiation. We retained patients with age between 20 and 99 years and non-missing data regarding race, sex, and primary cause of end-stage renal disease (ESRD). We followed patients from first date of PD until the earliest of conversion to HD (defined as treatment with HD for ≥2 months), death, kidney transplant, or recovery of renal function, but for a maximum of one year. We calculated crude rates of conversion from PD to HD in each per-annum cohort and used Fine-Gray regression to estimate the relative hazard of conversion from PD to HD as a function of PD initiation year, with adjustment for age, race, sex, and primary cause of ESRD.
Results
The number of incident patients on PD reached a nadir of 7924 in the 2008 cohort and monotonically increased thereafter, with 14,273 incident patients on PD in the 2015 cohort. Mean age increased slightly during the study era and reached 59.0 years in the 2015 cohort. The rate of conversion from PD to HD was 20.8 events per 100 patient-years in the 2006 cohort and reached a low of 17.6 events per 100 patient-years in 3 subsequent cohorts: 2010, 2013, and 2015. By Fine-Gray regression, with the 2010-2011 cohorts as referent, the adjusted hazard ratios of conversion from PD to HD were 1.10 (P < 0.001) in both the 2006-2007 and 2008-2009 cohorts and 0.99 (P > 0.5) in both the 2012-2013 and 2014-2015 cohorts.
Conclusion
Although the number of incident patients on PD grew every year from 2008 to 2015, the rate of conversion from PD to HD during the first year after initiation of PD was essentially unchanged between 2010 and 2015.
Funding
- Commercial Support –