Outcomes of peritoneal dialysis patients and switching to hemodialysis: a competing risks analysis.
BACKGROUND
We performed a review of a large incident peritoneal dialysis cohort to establish the impact of current practice and that of switching to hemodialysis.


METHODS
Patients starting peritoneal dialysis between 2004 and 2010 were included and clinical data at start of dialysis recorded. Competing risk analysis and Cox proportional hazards model with time-varying covariate (technique failure) were used.


RESULTS
Of 286 patients (median age 57 years) followed for a median of 24.2 months, 76 were transplanted and 102 died. Outcome probabilities at 3 and 5 years respectively were 0.69 and 0.53 for patient survival (or transplantation) and 0.33 and 0.42 for technique failure. Peritonitis caused technique failure in 42%, but ultrafiltration failure accounted only for 6.3%. Davies comorbidity grade, creatinine and obesity (but not residual renal function or age) predicted technique failure. Due to peritonitis deaths, technique failure was an independent predictor of death hazard. When successful switch to hemodialysis (surviving more than 60 days after technique failure) and its timing were analyzed, no adverse impact on survival in adjusted analysis was found. However, hemodialysis via central venous line was associated with an elevated death hazard as compared to staying on peritoneal dialysis, or hemodialysis through a fistula (adjusted analysis hazard ratio 1.97 (1.02 - 3.80)).


CONCLUSIONS
Once the patients survive the first 60 days after technique failure, the switch to hemodialysis does not adversely affect patient outcomes. The nature of vascular access has a significant impact on outcome after peritoneal dialysis failure.
Department of Nephrology, University Medical Center Ljubljana, Slovenia; Manchester Royal Infirmary Renal Unit, Manchester, UK; Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Manchester, UK; and Institute for Biostatistics and Medical Informatics, Faculty of Medicine, Ljubljana, Slovenia.
Jernej
J
Pajek
Department of Nephrology, University Medical Center Ljubljana, Slovenia; Manchester Royal Infirmary Renal Unit, Manchester, UK; Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Manchester, UK; and Institute for Biostatistics and Medical Informatics, Faculty of Medicine, Ljubljana, Slovenia.
Alastair J
AJ
Hutchison
Department of Nephrology, University Medical Center Ljubljana, Slovenia; Manchester Royal Infirmary Renal Unit, Manchester, UK; Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Manchester, UK; and Institute for Biostatistics and Medical Informatics, Faculty of Medicine, Ljubljana, Slovenia.
Shiv
S
Bhutani
Department of Nephrology, University Medical Center Ljubljana, Slovenia; Manchester Royal Infirmary Renal Unit, Manchester, UK; Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Manchester, UK; and Institute for Biostatistics and Medical Informatics, Faculty of Medicine, Ljubljana, Slovenia.
Paul E C
PE
Brenchley
Department of Nephrology, University Medical Center Ljubljana, Slovenia; Manchester Royal Infirmary Renal Unit, Manchester, UK; Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Manchester, UK; and Institute for Biostatistics and Medical Informatics, Faculty of Medicine, Ljubljana, Slovenia.
Helen
H
Hurst
Department of Nephrology, University Medical Center Ljubljana, Slovenia; Manchester Royal Infirmary Renal Unit, Manchester, UK; Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Manchester, UK; and Institute for Biostatistics and Medical Informatics, Faculty of Medicine, Ljubljana, Slovenia.
Maja Pohar
MP
Perme
Department of Nephrology, University Medical Center Ljubljana, Slovenia; Manchester Royal Infirmary Renal Unit, Manchester, UK; Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Manchester, UK; and Institute for Biostatistics and Medical Informatics, Faculty of Medicine, Ljubljana, Slovenia.
Angela M
AM
Summers
Department of Nephrology, University Medical Center Ljubljana, Slovenia; Manchester Royal Infirmary Renal Unit, Manchester, UK; Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Manchester, UK; and Institute for Biostatistics and Medical Informatics, Faculty of Medicine, Ljubljana, Slovenia.
Anand
A
Vardhan
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods*; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D017524:Slovenia / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
Epidemiology; body mass index; survival; technique failure; vascular access