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Abstract: FR-PO500

Peritoneal Dialysis Modality Survival

Session Information

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Harford, Antonia, Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Paine, S., Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Li, Nien Chen, Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Majchrzak, Karen M., Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Argyropoulos, Christos, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States
  • Roumelioti, Maria-Eleni, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States
  • Pankratz, V. Shane, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States
  • Miskulin, Dana, Tufts Medical Center, Boston, Massachusetts, United States
  • Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States
  • Hsu, Caroline M., Tufts Medical Center, Boston, Massachusetts, United States
  • Manley, Harold J., Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Salenger, Page, Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Johnson, Doug, Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Lacson, Eduardo K., Dialysis Clinic Inc, Nashville, Tennessee, United States
Background

Given limited modality longevity, we evaluated incident peritoneal dialysis (PD) patients at different time points after ESRD start date to identify modifiable factors to improve modality survival.

Methods

Incident dialysis patients treated by a national not-for-profit dialysis provider from Jan 2010-Dec 2019 were included in multivariable time-dependent survival analyses. A priori, patients were stratified into 3 groups: PD as initial modality; early conversion from HD to PD (<90 days); or late conversion to PD (≥90 days). Other model variables included patient and facility characteristics. The outcome of interest was sustained transfer to HD for >90 days. Transplant, death or dialysis withdrawal while remaining on PD were considered as competing events. Patients were censored at 5 years follow-up, loss to follow-up or study end.

Results

Among 5173 PD patients, 3132 patients initiated dialysis with PD, 937 transitioned early and 1104 transitioned late; 1459/5173 (28%) of the entire cohort subsequently switched from PD to HD. Patients who initiated dialysis with PD were at lowest risk of modality switch, while those with ≥2 peritonitis episodes had the highest risk of modality switch. Prior HD exposure was associated with lower PD modality survival, while higher renal (KRt/V) and peritoneal (KPt/V) clearances and higher serum albumin were associated with lower modality switch risk (Table). Patient age, sex, race, ESRD cause, number of training days, PD program size and year of training were not significant.

Conclusion

Initiating dialysis with PD is associated with increased modality survival while other potentially modifiable factors including peritonitis are associated with decreased PD longevity, highlighting potential strategies including preserving residual renal function and peritoneal membrane function which may increase PD modality survival.