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Abstract: TH-PO377

Early Mortality Hazard of Peritoneal Dialysis Is Also Present in Dialysis Modality Converted Patients

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Jeong, Jong Cheol, Ajou University Hospital, Suwon, Korea (the Republic of)
  • Kim, Sejoong, Seoul National University Bundang Hospital, Seongnam, GyeongGi-Do, Korea (the Republic of)
  • Jin, Dong-Chan, The catholic university of Korea, Suwon, Korea (the Republic of)
  • Na, Ki Young, Seoul National University Bundang Hospital, Seongnam, GyeongGi-Do, Korea (the Republic of)
Background

Peritoneal dialysis showed increased mortality in previous registry reports from east Asian countries. However, hazard pattern according to time have never been investigated. Also, there have been few reports about the outcome of dialysis modality converted patients. We examined 22,210 incident dialysis patients from Korean Society of Nephrology registry.

Methods

We evaluated whether hazard ratio of peritoneal dialysis has time-dependent nature. Survival analysis was performed using a non-proportional hazard fractional polynomial model. Treatment effect of peritoneal dialysis was tested by using inverse probability weighted regression adjustment

Results

During a median follow up of 7.9 years (from 0 to 13.9 years), 13,218/22,210 (59.5%) patients died. Peritoneal dialysis showed significantly elevated hazard ratio till 8 years after dialysis initiation, which has its peak value reaching 1.4 at 3 years. Multivariable analysis adjusted for age at dialysis initiation, sex, and cause of end stage renal disease was conducted. The average treatment effect of peritoneal dialysis showed -0.946 (95% C.I. -1.356 - -0.536, p<0.001) of beta, which is interpreted as -0.946 years less survival in average peritoneal dialysis group. Within those patients who died before 8 years, death related to diabetes was more prevalent in peritoneal dialysis group (35.5% vs 27.8%, p<0.001) For the dialysis modality converted patients, 1,561 patients were analyzed. Peritoneal dialysis converted from hemodialysis showed worse survival with an early bimodal peak of increased hazard ratio.

Conclusion

Peritoneal dialysis showed increased early mortality hazard. Early death within 8 years of peritoneal dialysis might be associated with metabolic risk. This phenomenon was also present for the dialysis modality converted patients.

Figure A. Early mortality hazard is elevated in peritoneal dialysis. B. Bimodal peak of early mortality hazard of peritoneal dialysis.
HR, hazard ratio; PD, peritoneal dialysis; HD, hemodialysis