Abstract: FR-PO1067
Effect of Hemodialysis (HD) Duration and Repeated Transitions on Peritoneal Dialysis-to-HD Transition Burden
Session Information
- Home Dialysis: Modalities, Barriers, Utilization, and Clinical Outcomes
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Desbiens, Louis-Charles, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
- Robitaille, Émilie, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
- Moore, Lynne, Universite Laval Faculte de Medecine, Québec City, Quebec, Canada
- Goupil, Remi, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
- Tennankore, Karthik K., Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
- Perl, Jeffrey, Unity Health Toronto, Toronto, Ontario, Canada
- Chan, Christopher T., Unity Health Toronto, Toronto, Ontario, Canada
- Nadeau-Fredette, Annie-Claire, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
Background
Peritoneal dialysis (PD) to hemodialysis (HD) transitions are the most frequent dialysis modality transition. These transitions are often defined by a minimum consecutive duration of HD (i.e. 90 days) and evaluated without considering repeated transitions within the same patient. We aimed to (1) characterize the overall burden of PD-to-HD transitions and (2) investigate how chosen duration cutoffs and repeated events impact their evaluation.
Methods
We studied patients initiating PD between 2005 and 2017 in the Canadian Organ Replacement Register (except Quebec and Manitoba). Patients were followed for 2 years and censored at transplant or death. PD-to-HD transitions were classified by inclusive (> 1 day of HD) or standard definitions (30, 60 and 90 days of HD). Analyses were repeated with and without consideration of multiple transitions in the same individual. Transition burden was examined using mean cumulative counts (MCC; cumulative incidences accounting for multiple events) with bootstrapped confidence intervals. Incidence rates and median time in PD were also computed.
Results
Among 15,559 patients who initiated PD, 6,316 experienced a total of 9,239 PD-to-HD transitions, at a median of 10 months (IQR 4-17). Using the inclusive definition, most patients (75%) experienced a single transition, 15% had two transitions and 10% had three and more. Overall, 44% of transitions lasted less than 30 days (time on HD), 14% lasted 30 to 90 days, and 42% extended beyond 90 days. The MCC for PD-to-HD transitions (most inclusive definition) was 0.72 transition/patient (95% CI 0.70-0.74) and the incidence rate 0.41 transition/patient-year (95% CI 0.41-0.42). Standard definitions with minimum HD durations underestimated transitions MCCs by up to 58% (Fig A). Only considering the first transition underestimated MCCs by 15% (standard definition 90 days) to 42% (inclusive definition; Fig B). Standard definitions overestimated the median time spent in PD by up to 25% (1.93 vs 1.54 years).
Conclusion
Usual definitions underestimate the clinical burden of PD-to-HD transitions. Registry studies should evaluate both standard and inclusive definitions with repeated transitions.
Funding
- Government Support – Non-U.S.