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Abstract
BackgroundThe use of peritoneal dialysis (PD) has declined in the United States over the past decade and technique failure is also reportedly higher in PD compared to hemodialysis (HD), but there are little data in the United States addressing the factors and outcomes associated with switching modalities from PD to HD.MethodsIn a prospective cohort study of 262 PD patients enrolled from 28 peritoneal dialysis clinics in 13 U.S. states, we examined potential predictors of switching from PD to HD (including demographics, clinical factors, and laboratory values) and the association of switching with mortality. Cox proportional hazards regression was used to assess relative hazards (RH) of switching and of mortality in PD patients who switched to HD.ResultsAmong 262 PD patients, 24.8% switched to HD; with more than 70% switching within the first 2 years. Infectious peritonitis was the leading cause of switching. Patients of black race and with higher body mass index were significantly more likely to switch from PD to HD, RH (95% CI) of 5.01 (1.15–21.8) for black versus white and 1.09 (1.03–1.16) per 1 kg/m2 increase in BMI, respectively. There was no difference in survival between switchers and non-switchers, RH (95% CI) of 0.89 (0.41–1.93).ConclusionSwitching from PD to HD occurs early and the rate is high, threatening long-term viability of PD programs. Several patient characteristics were associated with the risk of switching. However, there was no survival difference between switchers and non-switchers, reassuring providers and patients that PD technique failure is not necessarily associated with poor prognosis.
Highlights
The use of peritoneal dialysis (PD) has declined in the United States over the past decade and technique failure is reportedly higher in PD compared to hemodialysis (HD), but there are little data in the United States addressing the factors and outcomes associated with switching modalities from PD to HD
Patient characteristics Among the 262 peritoneal dialysis patients, 24.8% switched to hemodialysis during the study period
Causes of switching and time to switch from peritoneal dialysis to hemodialysis More than 40% of the PD patients who switched to HD did so within the first year after starting PD and more than 70% within the first two years (Figure 1)
Summary
The use of peritoneal dialysis (PD) has declined in the United States over the past decade and technique failure is reportedly higher in PD compared to hemodialysis (HD), but there are little data in the United States addressing the factors and outcomes associated with switching modalities from PD to HD. The number of incident end-stage renal disease (ESRD) patients initiating PD has declined over the same time period [3]. This decline in PD utilization has been observed in the United States and in Europe and elsewhere [3,4]. Peritonitis has been described as one of the leading causes of transfer from PD to HD [7,8,9] and only a small group of patients can return to PD after severe peritonitis and Tenckhoff catheter removal [10]
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