Kidney Week

Abstract: TH-PO391

Identification of Factors That Are Associated with Risk of Modality Failure Among Patients Treated with Peritoneal Dialysis

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

• Brunelli, Steven M., DaVita Clinical Research, Minneapolis, Minnesota, United States

Steven M. Brunelli,

• Cohen, Dena E., DaVita Clinical Research, Minneapolis, Minnesota, United States

Dena E. Cohen,

• Gray, Kathryn S., DaVita Clinical Research, Minneapolis, Minnesota, United States

Kathryn S. Gray,

• Cassin, Michelle, DaVita Kidney Care, Denver, Colorado, United States

Michelle Cassin,

• Van hout, Bram, DaVita Kidney Care, Denver, Colorado, United States

Bram Van hout,

• Rodriguez, Julie A., DaVita Kidney Care, Denver, Colorado, United States

Julie A. Rodriguez,

• Van Wyck, David B., DaVita Institute for Patient Safety, Denver, Colorado, United States

David B. Van Wyck,

• Schreiber, Martin J., DaVita Kidney Care, Denver, Colorado, United States

Martin J. Schreiber,

Background

Treatment with peritoneal dialysis (PD) is associated with better quality of life and clinical outcomes compared to in-center hemodialysis (ICHD). However, a substantial number of patients who initiate PD later fail the modality and switch to ICHD. Identification of factors that are associated with greater risk of modality failure may facilitate targeted interventions to retain patients on PD.

Methods

This retrospective, observational study considered adult patients who, during 2014-2016, were either prevalent on PD or initiated the modality during that time. Data were derived from deidentified electronic health records. The index event was considered as the first of at least 3 consecutive PD treatments (exclusive of training treatments). Follow-up time began on the first day of the calendar month after index and continued until modality failure, or until censoring for study end (31 July 2017) or loss to follow-up. Exposures were time-updated on a monthly basis. In this time to event analysis, Cox regression models (with robust variance estimators) were each tested on a bivariable basis against outcome, followed by joint modeling where multiple potential factors were entered into the model simultaneously. Models were adjusted for age, sex, race, history of congestive heart failure or amputation, and Charlson comorbidity index. Interactions were tested using likelihood ratio testing.

Results

This analysis considered a total of 303,126 patient-months. Factors associated with increased risk of PD modality failure included use of continuous ambulatory PD, total daily exchange volume >12L, indication that the patient needed support for treatment, weight >100kg, change in weight of >2kg, low serum albumin or change in albumin >0.4mg/dL, Kt/V<1.7, hospital admission, and clinical indications of peritonitis. Factors associated with a lower risk of modality failure were receipt of ≥4 retraining sessions, residing >20 miles from the treatment center, albumin>4.0 mg/dL, and treatment in a facility with >150 patients or a facility in which ICHD was not available.

Conclusion

Modifiable factors may contribute to the risk of modality failure among patients treated with PD. Programs targeting these factors may improve time on therapy for patients using this modality.

Funding

• Commercial Support –