title: Outcome of the sub-optimal dialysis starter on peritoneal dialysis. Report from the French Language Peritoneal Dialysis Registry (RDPLF).
abstract: BACKGROUND
  This study was carried out to examine the association of sub-optimal dialysis initiation of peritoneal dialysis (PD) with all the possible outcomes on PD using survival analysis in the presence of competing risks.
  
  
  METHODS
  This was a retrospective cohort study based on the data of the French Language Peritoneal Dialysis Registry. We analysed 8527 incident patients starting PD between January 2002 and December 2010. The end of the observation period was 01 June 2011. Times from the start of PD to death, transplantation, transfer to haemodialysis (HD) and first peritonitis episode were calculated. The sub-optimal dialysis initiation was defined by a period of <30 days on HD before PD initiation.
  
  
  RESULTS
  Among 8527 patients, there were 568 patients who started PD after <30 days on HD. There were 6562 events: 3078 deaths, 2136 transfers to HD, 1348 renal transplantations. When using a Fine and Gray model, sub-optimal dialysis start, early peritonitis and transplant failure were associated with a higher sub-distribution relative hazard of technique failure. There was no association between the sub-optimal dialysis start and the sub-distribution hazard of death or transplantation. In the multivariate analysis using a Fine and Gray regression model, the sub-optimal dialysis start was not associated with a higher sub distribution relative hazard of peritonitis.
  
  
  CONCLUSIONS
  Sub-optimal dialysis initiation is neither associated with a higher risk of death nor with a lower risk of renal transplantation. Sub-optimal PD patients had a higher risk of transfer to HD.
authors.affiliation: Néphrologie, CHU Clemenceau, Caen CEDEX, France. lobbedez-t@chu-caen.fr
authors.forename: Thierry
authors.initials: T
authors.lastname: Lobbedez
authors.forename: Christian
authors.initials: C
authors.lastname: Verger
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Ryckelynck
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Fabre
authors.forename: David
authors.initials: D
authors.lastname: Evans
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000628:therapy; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000401:mortality*; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
keywords: peritoneal dialysis; unplanned dialysis