High membrane transport status on peritoneal dialysis is not associated with reduced survival following transfer to haemodialysis.
BACKGROUND
High transporter status is associated with reduced survival of patients receiving peritoneal dialysis (PD). This may be due primarily to the development of complications related to the PD process, in which case the survival disadvantage may not persist following transfer to haemodialysis (HD). In this study, we aimed to assess the impact of peritoneal membrane transporter status on patient survival and the likelihood of return to PD following transfer from PD to HD.


METHODS
The Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry was searched to identify all patients between 1 April 1999 and 31 March 2004 who had received PD and subsequently transferred to HD, in whom an incident 4 h dialysate: plasma creatinine ratio was recorded. A Cox proportional hazards model was used to identify factors significantly associated with patient and technique survival after commencement of HD.


RESULTS
A total of 918 patients were included in the analysis. On multivariate Cox regression analysis there was no difference in survival between transport groups relative to the reference group of low average transporters (adjusted hazard ratio (HR) 0.71, 95% CI 0.42-1.19, P = 0.19, HR 0.94, 95% CI 0.63-1.38, P = 0.73 and HR 0.24, 95% CI 0.06-1.01, P = 0.051 for high, high average and low transporter groups, respectively). Significant predictors of mortality were duration of PD more than 22 months (HR 2.32, 95% CI 1.24-4.33, P = 0.01), increasing age, late referral to a nephrologist and a history of diabetes mellitus. The likelihood of returning to PD was increased if initial PD technique failure was due to mechanical complications compared with all other causes of failure [HR 3.65 (95% CI 2.78-4.79) P < 0.001] and decreased with higher body mass index [HR 0.97 per kg/m(2) (95% CI 0.94-0.99), P = 0.01] and the 4 h dialysate: plasma creatinine ratio considered as a continuous variable [4 h D:P Cr; HR 0.32 per unit (95% CI 0.12-0.89), P = 0.03].


CONCLUSIONS
The survival disadvantage associated with high peritoneal membrane transport status during PD treatment does not persist following transfer to HD. Early transfer to HD may be beneficial in this patient group.
Wiggins
Kathryn J
KJ
Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia. kate.wiggins@svhm.org.au
McDonald
Stephen P
SP
Brown
Fiona G
FG
Rosman
Johan B
JB
Johnson
David W
DW
D000368:Aged; D001315:Australia; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008566:Membranes / Q000378:metabolism; D008875:Middle Aged; D015233:Models, Statistical; D009520:New Zealand; D010530:Peritoneal Dialysis / Q000379:methods*; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome