Abstract: FR-PO1081
Life-Sustaining Treatments in Peritoneal Dialysis: Patient Preferences and Actual Interventions Received
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
Author
- Lai, Chun-Fu, National Taiwan University Hospital, Taipei City, Taiwan
Background
Patients with advanced kidney failure frequently receive intensive life-sustaining treatments despite limited survival benefits. While hemodialysis populations often prefer aggressive care, end-of-life (EOL) preferences of peritoneal dialysis (PD) patients—who possess higher baseline functional status and autonomy—remain understudied.
Methods
We prospectively enrolled 364 PD patients (response rate, 91.0%) between December 2021 and March 2022. Preferences for cardiopulmonary resuscitation (CPR), serious illness interventions, artificial nutrition and hydration, and health outcome priorities were evaluated using an extended Physician Orders for Life-Sustaining Treatment (POLST)-based questionnaire. Participants were followed until March 2024. Multivariable logistic regression identified independent predictors of CPR preference. Retrospective chart reviews assessed the alignment between documented preferences and actual EOL interventions.
Results
At baseline, 268 patients (73.6%) preferred a do-not-resuscitate (DNR) order, whereas 96 (26.4%) opted for CPR. Independent predictors of selecting CPR included younger age (odds ratio [OR] 0.96; 95% CI 0.94–0.98), male sex (OR 2.61; 95% CI 1.56–4.39), and higher residual kidney Kt/V (OR 2.59; 95% CI 1.29–5.16). While the vast majority of patients (87.1%) prioritized comfort care, those preferring CPR exhibited highly consistent choices, significantly favoring life-prolonging interventions and long-term artificial nutrition. During the 2-year follow-up, 31 participants died. Notably, 7 of these patients (22.6%) experienced divergent EOL care; 6 of the 7 mismatched cases involved patients receiving CPR despite having explicitly a DNR preference initially.
Conclusion
A substantial majority of PD patients prioritize DNR and comfort-focused care. While actual EOL care broadly aligned with these preferences for most, a subset still received aggressive interventions diverging from initial survey responses.
Preferences for serious illness treatments in PD patients.