ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: FR-OR007

International Trends in Mortality Soon after Switch from Peritoneal Dialysis to In-Center Hemodialysis: Results from the INTEGRATED Study Group

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Sukul, Nidhi, University of Michigan, Ann Arbor, Michigan, United States
  • Mukhopadhyay, Purna, Arbor Research Collabortaive for Health, Ann Arbor, Michigan, United States
  • Kramer, Anneke, ERA-EDTA Registry, Amsterdam, Netherlands
  • Jager, Kitty J., Academic Medical Center, Amsterdam, Netherlands
  • Lambie, Mark, Keele University, Crewe, United Kingdom
  • Sloand, James A., Baxter Healthcare Corporation, Northbrook, Illinois, United States
  • Van Biesen, Wim, Ghent University, Ghent, Belgium
  • Davies, Simon J., University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
  • Chan, Christopher T., Toronto General Hospital, Toronto, Ontario, Canada
  • Perl, Jeffrey, St. Michael's Hospital, Toronto, Ontario, Canada
  • Johnson, David W., Princess Alexandra Hospital, Brisbane, Queensland, Australia
  • 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
  • Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States
  • Nadeau-Fredette, Annie-Claire, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
Background

Switching between dialysis modalities is common among patients (pts) with end-stage kidney disease (ESKD) and has been shown to be associated with adverse outcomes. This international registry study describes mortality rates after switch from peritoneal dialysis (PD) to in-center hemodialysis (HD).

Methods

Using four longstanding international registries (ANZ, CORR, ERA, USRDS), and with support from the NIDDK, this study analyzed incident PD pts, defined as starting PD within 180 days of ESKD incidence, who switched from PD to HD for ≥1 day. Pts were grouped into 3 cohorts by year of ESKD incidence (2000-2004, 2005-2009, 2010-2014). Crude mortality rates (per 100 patient-years [PY]) were calculated for the first 180 days after switch, with patients censored on the date of death, transplant, loss-to-follow up, or study end-date.

Results

In each registry, (1) mortality rate was highest during the first 30 days after switch to HD, subsequently declining to a stable rate by 120 to 180 days (Figure); (2) mortality rate decreased from the earliest to the most recent cohort, though remained high soon after switch to HD (Figure).

Conclusion

Transition from PD to HD is associated with high mortality rates internationally, especially during the first 30-day period. The lower mortality rates in recent years may reflect more timely transition and/or improved peri-transition care. Future studies should evaluate optimal timing of switch, as well as modifiable predictors of post-switch mortality, to increase the likelihood of successful transition and to improve clinical outcomes.

Funding

  • NIDDK Support