Analysis of technique and patient survival over time in patients undergoing peritoneal dialysis.
OBJECTIVE
This study used national claims data to investigate the technique and patient survival over time in incident peritoneal dialysis (PD) patients.


METHODS
Incident end-stage renal disease patients undergoing PD and older than 18 years were selected from Taiwan health insurance databases. These patients were grouped into three study periods according to year of dialysis initiation: 1997-2001, 2002-2006, and 2007-2011. The study end-points included technique failure and mortality.


RESULTS
The patients in the most recent era were older and more likely to have higher levels of comorbidity. Compared with the 1997-2001 group, the risks of technique failure were similar in the in the 2002-2006 (hazard ratio [HR] 1.10, 95 % confidence interval [CI] 0.98-1.24) and 2007-2011 groups (HR 1.11, 95 % CI 0.98-1.26), respectively. Relative to the 1997-2001 group, the risks of mortality were higher in the 2002-2006 group (HR 1.59, 95 % CI 1.26-2.02) and similar in the 2007-2011 group (HR 1.20, 95 % CI 0.93-1.55). Using icodextrin and automated peritoneal dialysis (APD) were associated with lower risks of technique failure (HR 0.62 and 0.86, 95 % CI 0.56-0.68 and 0.77-0.95, respectively) and mortality (HR 0.55 and 0.81, 95 % CI 0.45-0.66 and 0.67-0.99, respectively).


CONCLUSIONS
Despite increase in disease burden in the most recent era, the outcomes remained relatively stable. The use of APD and icodextrin appears to have significantly ameliorated the impact of the increase in comorbidity burden.
Graduate Institute of Clinical Medical Science, China Medical University, 91 Hsueh Shih Road, Taichung, 404, Taiwan.|Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan.|Division of Nephrology, China Medical University Hospital, Taichung, Taiwan.
I-Kuan
IK
Wang
Department of Biochemistry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Chi-Yu
CY
Lu
Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.|College of Medicine, China Medical University, Taichung, Taiwan.
Chih-Hsin
CH
Muo
Division of Nephrology, China Medical University Hospital, Taichung, Taiwan.
Chiz-Tzung
CT
Chang
Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Tzung-Hai
TH
Yen
Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan.|Division of Nephrology, China Medical University Hospital, Taichung, Taiwan.
Chiu-Ching
CC
Huang
Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan.|Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan.
Tsai-Chung
TC
Li
Graduate Institute of Clinical Medical Science, China Medical University, 91 Hsueh Shih Road, Taichung, 404, Taiwan. fcsung1008@yahoo.com.|Department of Health Services Administration, College of Public Health, China Medical University, Taichung, Taiwan. fcsung1008@yahoo.com.|Faculty of Public Health, Mahidol University, Bangkok, Thailand. fcsung1008@yahoo.com.
Fung-Chang
FC
Sung
D000367:Age Factors; D000704:Analysis of Variance; D002423:Cause of Death; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D008297:Male; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome
End-stage renal disease; Icodextrin; Mortality; Peritoneal dialysis; Technique survival