MO859TRANSITIONS BETWEEN THE DIFFERENT DIALYSIS MODALITIES AND THEIR EFFECT ON SURVIVALS: A SINGLE-CENTER STUDY

Abstract

Abstract Background and Aims An integrated care approach available today, which implies that most patients will use different modalities at different time points of their disease, creates a need to accumulate data on patient outcomes and survival when switching from one treatment modality to another. The aim was to compare survival after the transition from hemodialysis (HD) to continuous ambulatory peritoneal dialysis (CAPD) and after the transfer from CAPD to HD. Method A single-center retrospective trial included 20 (18.9%) from 106 initiating CAPD between January 2016 and December 2020 patients, who were transferred from CAPD to HD or from HD to CAPD through a follow-up period until December 2020. 2 groups of patients were identified: the 1st group included CAPD-to-HD transition patients, the 2d group - HD-to-CAPD transition patients. At the end of a follow-up, the transfer's causes, outcomes, and cohort life expectancy (CLE) on the new treatment modality were evaluated. Results A summary of patients' characteristics are shown in the table below. The patient's number in the 1st group was 13, in the 2d - 7. Transfer causes in the 1st group were peritonitis (76.9%), leakage (15.4%), in the 2d group - vascular access problems (57.1%), poor hemodialysis tolerance (28.6%). In both groups in 1 case transfer cause was the patient's preference (7.7% and 14.3% respectively). In the 1st group CAPD duration was 29 [13;50] months, transfer outcomes included death in 7 cases (53.8%), renal transplantation (RT) in 2 cases (15.4%), in 2 cases (15.4%) patients were alive and were on HD, in 2 cases (15.4%) patients later were transferred back to CAPD. In the 2d group HD duration was 23 [3;30] months, transfer outcomes included death in 2 cases (28.6%), RT in 2 cases (28.6%), in 3 cases (42.8%) patients were alive and on CAPD. In the 1st group in 6 from 7 cases (85.7%) patients died in the intensive care unit (ICU), the main causes of death included cardiovascular accidents - 42.8% (cardiac arrest, acute heart failure, stroke), sepsis - 28.6% (due to gallbladder empyema and diabetic foot sepsis), bleeding - 28.6% (due to essential thrombocythemia, undiagnosed peptic ulcer). In the 2d group all patients died at home, causes of death involved congestive heart failure - 50% and uremia - 50.0%. In the 1st group CLE was 3.4 months, in the 2d - 20.5 months. Conclusion Post-transfer mortality is higher in the CAPD-HD transition group. In most cases, such patients die faster and in more severe condition and almost always in the ICU. Almost half of the CAPD-to-HD transfer patients died due to cardiovascular complications. Therefore, when transferring a patient to HD, it is necessary to take into account the load exerted on the heart and blood vessels, as well as the risks of bleeding and sepsis.