title: The impact of transfer from hemodialysis on peritoneal dialysis technique survival.
abstract: BACKGROUND
  A significant proportion of peritoneal dialysis (PD) patients receive an initial period of hemodialysis (HD) before transitioning to PD ("PD-switch"). We sought to better understand the risks of PD technique failure (TF) and mortality for those patients compared with patients starting with PD as their first dialysis modality ("PD-first").
  
  
  METHODS
  Using Canadian Organ Replacement Register data, we compared the risk of PD TF between PD-first and PD-switch patients within the first year after HD initiation. In a secondary analysis, the PD-switch patients were stratified into three groups based on timing of the switch from initial HD to PD as follows: 0 - 90 days, 91 - 180 days, and 181 - 365 days. Each group was compared with PD-first patients for risk of PD TF and death.
  
  
  RESULTS
  Between 2001 and 2010, 9404 patients initiated PD as their first renal replacement therapy, and 3757 switched from HD to PD. After multivariable adjustment, the risk of PD TF was higher among PD-switch patients than among PD-first patients [adjusted hazard ratio (AHR): 1.37; 95% confidence interval (CI): 1.26 to 1.49], particularly within the first year after the switch from HD to PD (AHR: 1.51; 95% CI: 1.36 to 1.68). There was no association between time on HD within the first year and subsequent risk of PD TF. For all the stratified PD-switch groups, death rates were higher than those for PD-first patients.
  
  
  CONCLUSIONS
  Compared with patients who start renal replacement therapy with PD, those who transfer from HD to PD within the first year on dialysis experience higher rates of PD TF and death, with the highest risk being observed in the initial year after the switch to PD.
authors.affiliation: Division of Nephrology, Jewish General Hospital, McGill University, Montreal, Quebec.
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Nessim
authors.affiliation: Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Bargman
authors.affiliation: Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: S Vanita
authors.initials: SV
authors.lastname: Jassal
authors.affiliation: Division of Nephrology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Oliver
authors.affiliation: Canadian Institute of Health Information and The Canadian Organ Replacement Register, Toronto, Ontario, Canada.
authors.forename: Yingbo
authors.initials: Y
authors.lastname: Na
authors.affiliation: Division of Nephrology and The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Perl
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods*; D006435:Renal Dialysis / Q000379:methods / Q000401:mortality; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
keywords: Canadian Organ Replacement Register; hemodialysis; survival; technique failure; technique survival; transfer