Impact of Time-interval and Frequency of Hospitalization Due to Fluid Overload on Survival in Peritoneal Dialysis: Thailand Experience.

Abstract

Fluid overload (FO) is common and linked to high mortality in patients undergoing peritoneal dialysis (PD). This study evaluates the impact of the time interval and frequency of FO-related hospitalizations on mortality and patient survival rates in PD patients. Data from PD patients voluntarily registered in the Database of Peritoneal Dialysis in EXcel (DPEX) was reviewed. We included patients who started PD between January 2008 and December 2018, had a history of FO-related hospitalizations after starting PD, and were followed until December 2020 or death. We analyzed the time interval to the first FO-related hospitalization after starting PD, the number of such hospitalizations, and the cumulative FO-free time. Mortality and patient survival rates were calculated, and multiple Cox regression identified factors associated with mortality. Among 1,858 patients hospitalized due to FO, those hospitalized within 12 months of starting PD or with less than 12 months of cumulative FO-free time had high mortality rates of 38.8 and 40.3 per 100 patient-years, respectively. One-year survival rates were 70.1% for those with a time to first FO-related hospitalization within 12 months of starting PD and 68.7% for those with less than 12 months of cumulative FO-free time. Adjusted hazard ratios were 2.92 (2.31-3.69) for a cumulative FO-free time of less than 12 months, 1.53 (1.18-1.99) for a time to first FO-related hospitalization within 12 months, and 1.05 (1.03-1.07) per FO-related hospitalization. The time interval to the development of FO significantly impacts mortality in patients undergoing peritoneal dialysis.