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Abstract: PO0968

Contemporary Incidence of Peritoneal Dialysis Attrition and Variability Therein Among Age Strata

Session Information

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Weinhandl, Eric D., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Gilbertson, David T., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Wetmore, James B., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Johansen, Kirsten L., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
Background

With an increasing percentage of patients performing dialysis in the home setting, quality measurement systems should increase focus on home dialysis outcomes. Considering the central role of peritoneal dialysis (PD) in home dialysis, an important and readily estimable measure is the duration of PD before initiation of hemodialysis. We estimated the cumulative incidence of attrition due to initiation of hemodialysis among patients who recently initiated PD in the United States and assessed variability of incidence among age strata.

Methods

We analyzed United States Renal Data System Standard Analysis Files. We identified all patients who initiated PD in the home setting between January 1, 2011, and September 30, 2018, and within one year after diagnosis of end stage kidney disease (ESKD). We classified patients into cohorts of age 18-44, 45-64, 65-74, and ≥75 years. Overall and within age strata, we estimated the 5-year cumulative incidence of conversion to hemodialysis, with accounting for the competing risks of death and kidney transplantation.

Results

The cohort included 111,464 patients who initiated PD. The cumulative incidence of conversion to hemodialysis was 22.4% at 1 year, 33.9% at 2 years, 41.4% at 3 years, 46.3% at 4 years, and 49.4% at 5 years (figure). During those 5 years, 25.4% of patients died while receiving PD and 12.8% received a kidney transplant, thereby resulting in only 12.4% of patients still performing PD after 5 years. Among patients aged 18-44 years, 1-year (5-year) cumulative incidence of conversion to hemodialysis was 23.3% (51.1%); corresponding estimates were 22.3% (52.0%) among patients aged 45-64 years (48.3%), 21.9% among patients aged 65-74 years, and 22.5% (41.6%) among patients aged ≥75 years.

Conclusion

Regardless of age, between 22% and 23% of patients who initiated PD during the first year of ESKD transferred to hemodialysis within one year.

Funding

  • NIDDK Support