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Abstract: FR-PO535

Declining Peritonitis Rates Incompletely Translate into Improved Technique Survival in Australian Peritoneal Dialysis Patients

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Khelgi, Vinod, Royal Adelaide Hospital, Adelaide, South Australia, Australia
  • Murthy, Suresh, Royal Adelaide Hospital, Adelaide, South Australia, Australia
  • McDonald, Stephen P., Royal Adelaide Hospital, Adelaide, South Australia, Australia
Background

Peritoneal Dialysis (PD) peritonitis rates are declining, but not matched by a uniform reduction in technique failure (TF) rates. Understanding the reasons for this disconnect will potentially help identify new targets for intervention.

Methods

13653 incident PD patients undergoing first PD treatment episodes in Australia between 2003 and 2017 were analysed for TF in 3-year cohorts. Instances of TF were segregated into infective or non-infective causes and cumulative incidences (CI) calculated at 1- and 2 years of death-censored technique failure (transfer to HD for >30 days) with death as competing risks. CI calculated using the Fine and Grey method.

Results

The peritonitis rate in Australia halved over the observation period. There were substantial improvements in death rates during PD treatment. However, there were minimal or no changes in death-censored PD technique failure (DCTF). Adjustment for age and diabetes made of DCTF events at 1 year, the proportion attributed to infection fell from 44% to 28%, with a similar fall at 2 years. After adjustment for age and diabetes, there was a suggestion of moderate improvement among the most recent cohort.

Conclusion

PD peritonitis rates have declined substantially over the study period as have death rates, but overall technique survival has changed only modestly. Non-infective causes of DCTF are proportionately higher; identification of modifiable risk factors provide the next target to enhance PD outcomes.

Results
Year of PD start2003-20052006-20082009-20112012-20142015-2017
n24262809244929772992
CI (DCTF) at 1 year (95% CI)21 (.20-.23)21 (.19-.22).21 (.20-.23).19 (.18-.21).17 (.16-.19)
CI (DCTF) at 2 years (95% CI).35 (.33-.37).34 (.32-.35).34 (.32-.36).33 (.31-.35).32 (.30-.35)
Subhazard ratio (adjusted for age / diabetes)1.00.99 (0.91-1.06)1.0 (0.92-1.08)0.93 (0.86-1.00)0.80 (0.72-0.88)
Peritonitis rate (per p-year)0.60 (0.57-0.62)0.54 (0.53-0.56)0.43 (0.41-0.45)0.38 (0.37-0.40)0.30 (0.29-0.32)
Proportion infective DCTF 1yr (%)4440302428
Proportion infective DCTF 2yr4644322830
CI (death) at 1 year.10 (.09-.12).08 (.07-0.9).08 (.07-.09).05 (.04-.06).06 (.05-.07)
CI (death) at 2 year.20 (.18-.22).17 (.15-.18).14 (.13-.16).13 (.11-.14).13 (.12-.15)