Kidney Week

Abstract: TH-PO368

Switching Dialysis Modalities for a Better Outcome: Analysis from the United States Renal Data System (USRDS)

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

• Abifaraj, Farah, University of Texas Medical Branch at Galveston, Galveston, Texas, United States

Farah Abifaraj,

• Lal, Yasir, University of Texas Medical Branch, Galveston, Texas, United States

Yasir Lal,

• Fischer, Wayne G., University of Texas Medical Branch, Galveston, Texas, United States

Wayne G. Fischer,

• Badalamenti, John, University of Texas Medical Branch, Galveston, Texas, United States

John Badalamenti,

• Kassem, Hania, University of Texas Medical Branch, Galveston, Texas, United States

Hania Kassem,

Background

Since 2011, the prospective payment system dialysis bundle has created more incentive for providers to place patients (pts) on Peritoneal Dialysis (PD) leading to more pts switching from Hemodialysis (HD) to PD. Previous studies showed that, compared to pts who started with HD, those who started with PD were more likely to be white, younger, non-diabetic, and with less prevalence of obesity and other comorbidities. They were also described to have either better or similar survival. However, patient factors and outcome in those who switch from HD to PD have not been well described. In this study, we compared demographics and survival between pts on HD and those switched from HD to PD.

Methods

Using the USRDS, we analyzed demographics and mortality for 594,872 pts from May 2012 till December 2015. Kidney transplant recipients were excluded. Pts were divided into: HD only, PD only, and HD-to-PD switch groups. Comparison of continuous demographic variables, such as age, BMI, and albumin, was based on t-tests (pooled variances). Comparison of demographic categorical variables, such as sex, race, region, and presence of diabetes, was based on Contingency Analysis. Survival Analyses were performed using Kaplan-Meier curves. A Cox Proportional Hazards model was used to estimate the effects of predictor variables on pts survival as well as on PD modality survival after the switch.

Results

Comparing the HD only (n= 574,606) and switch groups (n= 20,266), we found that switch pts were more likely to be younger at time of 1^st ESRD service (5.0 years, p<0.01), males, white, non-diabetics, and to have a higher serum albumin (0.05 g/dl, p<0.01). Average BMI was surprisingly higher in the switch group (0.4 kg/m², p<0.01). The switch group had better survival than both the HD only and PD only groups. Among pts who switched, non-diabetics and those with a higher serum albumin had better overall survival as well as PD modality survival. BMI and sex had no significant effect on either.

Conclusion

Demographics in pts who transitioned from HD to PD were similar to those previously reported in pts initiated on PD. Additionally, the HD to PD group had improved survival. These findings provide insight into the demographics influencing the decision to switch pts to PD and the positive impact on survival among those pts.