Abstract: FR-PO0559
Attributable Influence of Peritoneal Dialysis on Survival Benefits Associated with Predialysis Kidney Care
Session Information
- Home Dialysis: Clinical Epidemiology
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Shukla, Ashutosh M., VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
- Scheiffele, Grant D., University of Florida, Gainesville, Florida, United States
- Parmar, Cydney El Cid, University of Florida, Gainesville, Florida, United States
- Huang, Wenxi Huang, University of Florida, Gainesville, Florida, United States
- Liu, Mei, University of Florida, Gainesville, Florida, United States
- Xu, Qi, University of Florida, Gainesville, Florida, United States
- Guo, Yi, University of Florida, Gainesville, Florida, United States
- Guo, Serena Jingchuan, University of Florida, Gainesville, Florida, United States
- Pramod, Sheena, University of Florida, Gainesville, Florida, United States
Background
Pre-dialysis renal care is associated with higher peritoneal dialysis (PD) use and longer survival on dialysis. Studies are conflicting but have showed a potential for early survival advantage with PD. However, conventional analyses comparing survival across dialysis modalities fail to fully account for these competing influences.
Methods
Analyzing 2021 USRDS, we identified all adult ESKD patients with >6-month pre-dialysis Medicare initiating hemodialysis between 2010-2019. Using causal mediation analysis with a 16-variable Cox Proportional Hazard model, and pre-dialysis renal care as exposure, PD (reference group: in-center hemodialysis, IHD) as mediator, and 3-year post-ESKD survivals as outcome, we examined the attributable influence of PD on the survival advantage conferred by pre-dialysis renal care. We conducted extensive sensitivity analyses modulating the exposure duration and subgroup analyses modulating mediators by comparing PD to IHD subgroups of incident mature and maturing AVF/AVG and central catheter.
Results
Of 464,310 eligible incident ESKD patients, 293,711(63%), 227,608(49%), and 140,269 (30%) received any, >6-month, and >12-month pre-dialysis renal care, respectively. Incident PD was used in 33,782(7.3%), with rest 427,866 using IHD. Compared to those without, pre-dialysis renal care was associated with 5-fold(aOR:4.77, 95%CI:4.56-4.96) higher use of PD and 26% lower mortality (aHR:0.74, 95%CI:0.74,0.75) at 3 years. Incident PD was associated with 30% lower 3-year mortality. Mediation analyses showed that differential PD use explained 7.5% of survival difference between those with and without pre-dialysis renal care (p<0.0001). Sensitivity analyses incorporating a longer pre-dialysis renal care slightly diminished but maintained significant attributable influence of PD on survival. Secondary analysis showed that the attributable influence of PD in pre-dialysis renal care survival advantage diminished when compared with incident mature vascular access but heightened when compared to central catheter.
Conclusion
By quantifying the attributable influence of PD and through extensive sensitivity and secondary analyses, our findings will highlight the importance of longitudinal renal care as a major determinant of post-ESKD survival.