#1114 Rate and reasons for peritoneal dialysis dropout following haemodialysis to peritoneal dialysis switch: a systematic review and meta-analysis

Abstract

Abstract Background and Aims Patient outcomes can be influenced by dialysis initiation and subsequent modality choices. This systematic review and meta-analysis aimed to explore the rate and reasons for peritoneal dialysis (PD) dropout following a haemodialysis (HD) to PD switch. Method This systematic review conducted searches in four databases, including Medline, PubMed, EMBASE, and Cochrane. The protocol was registered on PROSPERO (study ID: CRD42023405718). Outcomes included the rate and reasons for PD dropout and the mortality difference in two groups (PD first group versus HD to PD group). The Critical Appraisal Skills Programme (CASP) checklist and the GRADE tool were used to assess the quality of evidence. Results 4971 papers were detected, and 13 studies were included. On meta-analysis, there was no statistically significant difference in PD dropout in the PD first group (OR: 0.81; 95%CI: 0.61, 1.09; I2=83%; P=0.16), however, there was a statistically significant reduction in the rate of mortality (OR: 0.48; 95%CI: 0.25, 0.92; I2=73%; P=0.03) compared to the HD to PD group. Causes for PD dropout differed between the two groups, with psychosocial reasons more common in the HD to PD group. However, inadequate dialysis and peritonitis were the main reasons for PD dropout across both groups. Conclusion Compared to the PD first group, a previous HD history may not impact PD dropout rates for patients, but it could increase mortality in the HD to PD group. Reasons for PD dropout differed between the two groups, but there were no statistically significant differences. Exploring psychosocial reasons for PD dropout is a valuable area for future research.