title: Determinants of peritoneal dialysis technique failure in incident US patients.
abstract: OBJECTIVE
  Switching from peritoneal dialysis (PD) to hemodialysis (HD) is undesirable, because of complications from temporary vascular access, disruption of daily routine, and higher costs. Little is known about the role that social factors play in technique failure.
  
  
  METHODS
  We followed for 3 years a nationally representative cohort of US patients who initiated PD in 1996 - 1997. Technique failure was defined as any switch from PD to HD for 30 days or more. We used Cox regression to examine associations between technique failure and demographic, medical, social, and pre-dialysis factors. We estimated hazard ratios (HRs) with 95% confidence intervals (CIs).
  
  
  RESULTS
  We identified an inception cohort of 1587 patients undergoing PD. In multivariate analysis, female sex (HR: 0.78; 95% CI: 0.64 to 0.95) was associated with lower rates of technique failure, and black race [compared with white race (HR: 1.48; 95% CI: 1.20 to 1.82)] and receiving Medicaid (HR: 1.48; 95% CI: 1.17 to 1.86) were associated with higher rates. Compared with patients who worked full-time, those who were retired (HR: 1.49; 95% CI: 1.07 to 2.08) or disabled (HR: 1.38; 95% CI: 1.01 to 1.88) had higher rates of failure. Patients with a systolic blood pressure of 140 - 160 mmHg had a higher rate of failure than did those with a pressure of 120 - 140 mmHg (HR: 1.24; 95% CI: 1.00 to 1.52). Earlier referral to a nephrologist (>3 months before dialysis initiation) and the primary decision-maker for the dialysis modality (physician vs patient vs shared) were not associated with technique failure.
  
  
  CONCLUSIONS
  This study confirms that several socio-demographic factors are associated with technique failure, emphasizing the potential importance of social and financial support in maintaining PD.
authors.affiliation: Division of Nephrology, Stanford University School of Medicine, 780 Welch Road, Suite 106, Palo Alto, California 94305, USA. jishen@stanford.edu
authors.forename: Jenny I
authors.initials: JI
authors.lastname: Shen
authors.forename: Aya A
authors.initials: AA
authors.lastname: Mitani
authors.forename: Anjali B
authors.initials: AB
authors.lastname: Saxena
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Goldstein
authors.forename: Wolfgang C
authors.initials: WC
authors.lastname: Winkelmayer
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000379:methods; D012017:Referral and Consultation; D012307:Risk Factors; D012959:Socioeconomic Factors; D017211:Treatment Failure; D014481:United States