Peritoneal Dialysis Patient Transfers to Hemodialysis: Causes and Associated Risks.

Abstract

Background: The end of peritoneal dialysis (PD) can be marked by kidney transplantation, death, or transfer to hemodialysis (HD). We compared the risks of the different reasons for transfer to HD in PD patients according to the use of assistance for PD care, PD modality, and the suboptimal starter status.

Methods: This was a retrospective study using data from the French Language Peritoneal Dialysis Registry from patients who started PD between January 1, 2002, and December 31, 2018. We used Cox and Fine Gray survival models to evaluate the risks of transfer to HD due to PD inadequacy, infection, mechanical issue, psychosocial issue, others PD-related and others non-PD-related causes. Models were evaluated for three periods of PD vintage: 0 to 6 months, 6 to 18 months, and after 18 months.

Results: The study included 15,974 incident PD patients treated in 170 French PD units. There were 6,835 deaths, 5,108 transfers to HD and 3,092 renal transplantations. Nurse-assisted PD was associated with a lower risk of transfer to HD for infection in the first 18 months (cs-HR 0.51, 95%CI 0.31-0.83 before 6 months) and for adequacy issues after 6 months (cs-HR 0.59, 95%CI 0.51-0.70 after 18 months). The risk of transfer for mechanical issue was higher in CAPD compared to APD during the first eighteen months (cs-HR 1.41, 95%CI 1.00-1.99 before 6 months), but CAPD was associated with a lower risk for adequacy, infectious or mechanical issue after 18 months. Finally, suboptimal starters have a higher risk of transfer due to psychosocial challenges in the first 6 months (cs-HR 1.70, 95%CI 1.03-2.81).

Conclusions: Distinct factors are associated with the risk of transfer from PD to in-center HD, according to the cause of the transfer. Some preventive measures targeting these risk factors may help to maintain patients in PD.