Abstract
Technique failure is a frequent complication of peritoneal dialysis (PD), but the association between causes of death-censored technique failure and mortality remains unclear. Using Australian and New Zealand Dialysis and Transplant (ANZDATA) registry data, we examined the associations between technique failure causes and mortality in all incident PD patients who experienced technique failure between 1989–2014. Of 4663 patients, 2415 experienced technique failure attributed to infection, 883 to inadequate dialysis, 836 to mechanical failure and 529 to social reasons. Compared to infection, the adjusted hazard ratios (HR) for all-cause mortality in the first 2 years were 0.83 (95%CI 0.70–0.98) for inadequate dialysis, 0.78 (95%CI 0.66–0.93) for mechanical failure and 1.46 (95%CI 1.24–1.72) for social reasons. The estimates from the competing risk models were similar. There was an interaction between age and causes of technique failure (pinteraction < 0.001), such that the greatest premature mortality was observed in patients aged >60 years post social-related technique failure. There was no association between causes of technique failure and mortality beyond 2 years. In conclusion, infection and social-related technique failure are associated with premature mortality within 2 years post technique failure. Future studies examining the associations may help to improve outcomes in these patients.
Highlights
Despite the increasing acceptance of peritoneal dialysis (PD) as a treatment for patients with end-stage kidney disease (ESKD), PD technique failure remains an important and frequent complication of PD
In an analysis of the Australian and New Zealand Dialysis and Transplant (ANZDATA) registry of 6639 incident PD patients, 10% of patients who had experienced peritonitis died within 30 days of peritonitis[8], with similar findings corroborated in other studies[9]
Over 50% of the PD technique failure was attributed to infection (n = 2415, 52%), followed by inadequate dialysis (n = 883, 19%), mechanical failure (n = 836, 18%) and social reasons (n = 529, 11%) (Fig. 1)
Summary
Despite the increasing acceptance of peritoneal dialysis (PD) as a treatment for patients with end-stage kidney disease (ESKD), PD technique failure remains an important and frequent complication of PD. In Australia and New Zealand, almost 25% of prevalent PD patients experienced PD technique failure annually, with similar trends being observed in other countries including the United States and the United Kingdom[1,2,3]. In an analysis of the Australian and New Zealand Dialysis and Transplant (ANZDATA) registry of 6639 incident PD patients, 10% of patients who had experienced peritonitis died within 30 days of peritonitis[8], with similar findings corroborated in other studies[9]. These observations suggest that peritonitis is an important risk factor for both PD technique failure and premature mortality. The aims of this study were to examine the associations between causes of PD technique failure (other than death) and subsequent all-cause and cause-specific mortality, and to determine whether this association was modified by age
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