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Abstract: FR-PO512

Outcome Measures for Technique Failure Reported in Randomized [AT1] Trials in Patients on Peritoneal Dialysis: A Systematic Review

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Elphick, Emma H., Keele University, Crewe, United Kingdom
  • Holmes, Matthew James vaughton, Keele University, Crewe, United Kingdom
  • Tabinor, Matthew, Royal Wolverhampton Hospital, Stoke on Trent, United Kingdom
  • Davies, Simon J., Keele University, Crewe, United Kingdom
  • Manera, Karine E., The University of Sydney, Westmead, New South Wales, Australia
  • Johnson, David W., Princess Alexandra Hospital, Brisbane, Queensland, Australia
  • Perl, Jeffrey, St. Michael's Hospital, Toronto, Ontario, Canada
  • Tong, Allison, The University of Sydney, Westmead, New South Wales, Australia
  • Boudville, Neil, University of Western Australia, Nedlands, Western Australia, Australia
  • Lambie, Mark, Keele University, Crewe, United Kingdom
Background

Peritoneal dialysis (PD) technique failure (TF) has been identified as a core outcome by the Standardized Outcomes in Nephrology - Peritoneal Dialysis (SONG-PD) initiative to be reported in trials. However, the definition and measures used for TF are not standardized. We aimed to assess the scope and consistency of definitions and measures used for TF in trials in patients on PD.

Methods

MEDLINE, Embase and CENTRAL databases were searched for randomized trials conducted in patients on PD that reported TF as an outcome up until July 2018. The definition and measures used were extracted and independently assessed by two reviewers.

Results

We included 23 from 187 trials involving 41 to 371 participants, with follow-up durations ranging from 6 weeks to 4 years. The duration of hemodialysis required to define TF was reported in 6 (26%) trials, specifically: 30 days (2 trials), “permanent” without further definition (2 trials), continuing HD until censoring (1 trial) and “any duration” (1 trial). In 9 trials it was unclear how transfer to HD/death/transplant was accounted for in the analysis of TF. Eight trials reported only “transfer to HD” without further definition regarding transplantation/death, whereas death was a cause of TF in 4 trials and censored in the remaining 2 studies. No study included transplant in their definition of TF.
TF was reported as a frequency in 21 trials. Eighteen trials compared TF rates in the intervention and control groups, with 15 using a hazard ratio and the remaining 3 using unclear methodology. Attribution of TF was reported in 14 trials. Three trials reported only peritonitis-related TF without mentioning other causes of TF, with the remaining 11 studies reporting different reasons in each case.

Conclusion

There is substantial heterogeneity in how PD technique failure is defined and reported, likely contributing to substantial variability in reported rates. Standardized measures for reporting technique failure in PD trials are required.