Kidney Week

Abstract: FR-PO511

Long-Term Patient Survival Was Not Influenced by the Initial Modalities in Peritoneal Dialysis Patients: A Propensity Score-Adjusted Single-Center Study

Session Information

• Peritoneal Dialysis: Modality, Catheter, Infections
  November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 703 Dialysis: Peritoneal Dialysis

Authors

• Nakamura, Hironori, Shinonoi General Hospital, Nagano, Japan

Hironori Nakamura,

• Mariko, Anayama, Shinonoi General Hospital, Nagano, Japan

Anayama Mariko,

• Makino, Yasushi, Shinonoi General Hospital, Nagano, Japan

Yasushi Makino,

• Nagasawa, Masaki, Shinonoi General Hospital, Nagano, Japan

Masaki Nagasawa,

Background

The association between the modalities of peritoneal dialysis (PD) and long-term patient survival considerably differs among countries and remains unknown.

Methods

We retrospectively investigated the long-term survival rate of 146 Japanese patients, including those who switched from PD to hemodialysis (HD), and evaluated the correlation between survival time and clinical features at PD initiation, and the effect of using different dialysis modalities, continuous ambulatory peritoneal dialysis (CAPD) or automated PD (APD),on patient survival and their associated factors.

Results

The following patient characteristics were as follows: age (median,interquartile range), 65.0 (55.0–73.5) years; body mass index (BMI), 22.6 (20.8–25.9) kg/m²; diabetes, 35.0%; serum albumin level, 3.4 (2.9–3.8) g/dL; serum creatinine level, 8.3 (6.2–9.9) mg/dL; dialysate-to-plasma creatinine concentration ratio (D/PCr), 0.66 (0.54–0.77); and urine volume, 700 (305–1000) mL. Time on PD was 36.0 (17.0–64.5) months, and time on patient survival was 53.0 (20.0–103.0) months. The 5- and 10-year patient survival rates were 65.4% and 40.0%, respectively. Cox proportional hazard analysis revealed that patient survival was significantly affected by age (hazard ratio [HR], 1.08; 95% confidence interval [95% CI], 1.05–1.11; p < 0.001), diabetes (HR, 2.07; 95% CI, 1.18–3.63; p = 0.011), and D/PCr (HR, 8.31; 95% CI, 1.38–49.9; p = 0.021). When comparing CAPD (n = 57) with APD (n = 84), the Kaplan–Meier analysis showed the values for patient survival time as 61.0 (45.1–76.9) months for CAPD versus 140 (76.9–203.0) months for APD, log-rank test; p < 0.001. Baseline characteristics showed significant differences between CAPD and APD in age (70.0 vs. 60.5 years), ACE-I/ARB intake (41% vs. 68%), icodextrin (39% vs. 16%), and serum creatinine levels (8.1 vs. 9.0 mg/dL), respectively. After propensity score adjustment for choosing CAPD, the superiority for APD over CAPD disappeared (p = 0.756).

Conclusion

We conclude that patient survival in this population was superior to that in previous worldwide reports. Moreover, the selection of CAPD or APD for initial dialysis was not associated with long-term patient survival, following adjustment of the baseline characteristics.