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Abstract: FR-PO536

Risk Factors for Early Mortality After Switch from Peritoneal Dialysis to Hemodialysis: A Multinational Registry Study

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Nadeau-Fredette, Annie-Claire, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
  • Sukul, Nidhi, University of Michigan, Ann Arbor, Michigan, United States
  • Lambie, Mark, Keele University, Crewe, United Kingdom
  • Perl, Jeffrey, St. Michael's Hospital, Toronto, Ontario, Canada
  • Jager, Kitty J., ERA-EDTA Registry, Amsterdam, Netherlands
  • Johnson, David W., Princess Alexandra Hospital, Brisbane, Queensland, Australia
  • Davies, Simon J., Keele University, Crewe, United Kingdom
  • Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Kramer, Anneke, ERA-EDTA Registry, Amsterdam, Netherlands
  • Van Biesen, Wim, Ghent University, Ghent, Belgium
  • Chan, Christopher T., Toronto General Hospital, Toronto, Ontario, Canada

Group or Team Name

  • INTEGRATED study group
Background

Transfer to hemodialysis (HD) is frequent in peritoneal dialysis (PD), and mortality risk is highest in the early transition period to HD. We sought to identify risk factors of mortality after a PD to HD transition.

Methods

Incident PD patients (started on PD within 180 days of RRT initiation) who switched to HD for ≧1 day between 2000 and 2014 were identified, using registries from Australia/New Zealand (ANZDATA), Canada (CORR), Europe (ERA-EDTA), and the United States (USRDS). Separate multivariable Cox models were built for early (<90 days), medium (90-180 days) and late (>180 days) periods after switch to HD. Patients were followed after switch from PD to HD from the first day (model 1), day 90 (model 2) or day 180 (model 3) until death, censoring at time of kidney transplantation and end of follow-up.

Results

Overall, 6,669, 5,848, 21,574, and 80,459 patients were included from ANZDATA, CORR, ERA-EDTA and USRDS, respectively. Risk of mortality after switch to HD was lower in the most recent cohorts. Older patients were at increased risk of death, particularly during the first 90 days after switch. Similarly, the mortality risk associated with longer PD vintage was highest during the early periods after switch to HD, but attenuated afterwards. Males experienced lower risk of mortality early after transition to HD, but higher mortality risk after 180 days on HD.

Conclusion

In this multinational registry study, mortality risk factors varied by time period after switch from PD to HD. Females, older patients and patients with PD vintage >3 years before switching to HD were at greater risk of early mortality and should be followed more closely when transitioned to HD.

Funding

  • Commercial Support