Early technique failure in peritoneal dialysis patients in a multi-ethnic Asian country

Koniman, Riece; Foo, Marjorie Wai Yin; Johnson, David W.; Wu, Sin Yan; Hao, Ying; Jayaballa, Mathini; Phang, Chee Chin; Oei, Elizabeth Ley; Htay, Htay

doi:10.1007/s11255-020-02570-3

Cited by 3 publications

(6 citation statements)

References 19 publications

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“…In a Dutch study, deaths accounted for 69% of the total number of early technique failures [16]. Studies in South Korea, Singapore and Canada also demonstrated that death was the leading cause of early withdrawal from PD [11,12,17]. In our study, cardiovascular (CV) death was the leading cause of death (29.6%).…”

Section: Discussionsupporting

confidence: 49%

“…ANZDATA Study on 16,748 PD patients reported that 4,389 patients (26.2%) developed early technique failure (including death and transferring to HD) during the rst year of PD therapy. In a study of Singapore, 19% of patients developed to technique failure (including death and transferring to HD) in rst year after PD start [11]. A retrospective cohort study of 5,162 PD patients in Canadian showed that the 1-year conversion rate to HD was 12.7% [12].…”

Section: Discussionmentioning

confidence: 99%

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Incidence and Risk Factors Associated with Technique Failure in the First Year of Peritoneal Dialysis: A Single Center Retrospective Cohort Study in Southern China

Yang

Xiao

et al. 2022

Preprint

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Background: Technique failure is more likely to occur during the first 12 months after peritoneal dialysis (PD) initiation, which is a great challenge encountered in PD patients. The aim of this study was to investigate the incidence and risk factors associated with technique failure within the first year of PD patients in Southern China.Methods: Incident PD patients who were followed up for at least one year at The First Affiliated Hospital of Sun Yat-sen University from January 1, 2006 to December 31, 2015 were included. Technique failure was defined as transfer to hemodialysis (HD) for more than 30 days or death within the first year after start of PD. A competitive risk regression analysis was used to explore the incidence and risk factors of the technique failure. Results: Overall, 2,290 incident PD patients were included in this study, with a mean age of 48.2 ± 15.7 years, 40.9% female and 25.2% with diabetes. A total of 173 patients (7.5%) had technique failure during the first year of PD. Among them, the patient death account for 62.4%(n=108) and transferring to HD account for 37.6% (n=65). The main reasons for death were cardiovascular diseases (n=32, 29.6%), infection (n=15, 13.8%) and for conversion to HD were catheter dysfunction (n=28, 16.2%), infection (n=22, 12.7%). The risk factors for the technique failure included advanced age (HR 2.78, 95%CI 1.82-4.30), low body mass index (BMI＜18.5 kg/m2: HR 1.77, 95%CI 1.17-2.67), history of congestive heart failure (HR 2.81, 95%CI 1.58-4.98), or HD (HR 1.49, 95%CI 1.05-2.10), peritonitis (HR 2.02, 95%CI 1.36-3.01) ;while higher serum albumin (HR 0.93, 95%CI 0.89-0.96) and using employee medical insurance to pay expenses (HR 0.47, 95%CI 0.32-0.69) were associated with reduced risk.Conclusions: Advanced age, poor nutritional status, history of HD or congestive heart failure, and peritonitis are related factors that increase the risk of technique failure in first year of PD, while patients' type of medical insurance may also have an influence on early technique failure.

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Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors Associated with Technique Failure in the First Year of Peritoneal Dialysis: A Single Center Retrospective Cohort Study in Southern China

Yang

Xiao

et al. 2022

Preprint

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“…Indeed, some studies define PD discontinuation as the shift to HD irrespective of the duration and the cause of PD interruption [ 8 , 11 , 16 ]. Other studies define it as a shift to HD for more than 30 days [ 10 , 12 , 13 , 17 ] or 2 months [ 9 , 15 ] Alternatively, PD discontinuation has been defined as the occurrence of death by any cause [ 8 , 11 , 12 , 16 ]. Similarly, censoring for death or renal transplantation has been carried out inconsistently across studies and, although PD vintage is associated with discontinuation, there is no consensus on the definition of early vs late PD discontinuation (Table 1 ).…”

Section: Early Vs Late Pd Discontinuation Definitionmentioning

confidence: 99%

“…Rep. 9:3967 [ 14 ] All-cause mortality on PD Early technique failure in peritoneal dialysis patients in a multi‐ethnic Asian country (2020) International Urology and Nephrology. 52:1987–1994 [ 17 ] Discontinuation within the first year, defined as transfer to HD for ≥ 30 days, or death Peritoneal dialysis and mortality, kidney transplant, and transition to hemodialysis: trends from 1996–2015 in the United States (2020) Kidney Med. 2(5):610–619 [ 12 ] Transfer to in-center HD, or death Predictors of technique failure and mortality on peritoneal dialysis: an analysis of New Zealand peritoneal dialysis registry data (2021) :530–540.…”

Section: Early Vs Late Pd Discontinuation Definitionmentioning

confidence: 99%

“…72(2):188–197 https://doi.org/10.1053/j.ajkd.2017.10.019 [ 13 ] Older age (> 70 years) BMI < 18.5 kg/m 2 Diabetes History of ischemic heart disease, cerebrovascular disease or peripheral vascular disease Prior RRT Late referral to nephrology care Smaller centers Death (32.2%) Infections (24.0%) Mechanical causes (19.7%) Others (22.1%) 17.8% (2.976/16.748) transfer to HD c 8.4% (1.413/16.748) death c Early technique failure in peritoneal dialysis patients in a multi‐ethnic Asian country (2020) International Urology and Nephrology. 52:1987–1994 https://doi.org/10.1007/s11255-020-02570-3 [ 17 ] Peripheral vascular disease Etiology of ESKD Death (41.8%) Infections (40.8%), Mechanical causes (10.2%) Other causes (7.1%) 10.8% (57/528) transfer to HD c 7.8% (41/528) death c Factors associated with late pd discontinuation: other factors Adapted from: time-dependent reasons for peritoneal dialysis technique failure and mortality (2010) Perit Dial Int.30:170–177 https://doi.org/10.3747/pdi.2008.00277 [ 8 ] Loss of residual renal function Older age Diabetes, CV disease Death (about 25%) Psychosocial/unknown (about 7–9%) Catheter complications (1–2%) Transplantation (42–43%) Infections (10–18%) Under dialysis/UFF/abdominal complications (4–7%) 24% (after 2 years)) 34% (after 3 years) Predictors of outcomes in patients on peritoneal dialysis: a 2-year nationwide cohort study (2019) Sci. Rep. 9:3967 [ 14 ] Older age Diabetes and CV comorbidities Higher C-reactive protein and phosphate levels Reduced serum albumin Use of 2.5% glucose dialysate – 10% death 1.6% kidney transplantation 29.4% transfer to HD Adapted from: peritoneal dialysis and mortality, kidney transplant, and transition to hemodialysis: trends from 1996–2015 in the United States (2020) Kidney Med.…”

Section: Early Vs Late Pd Discontinuation Definitionmentioning

confidence: 99%

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Peritoneal dialysis discontinuation: to the root of the problem

Piarulli,

Vizzardi,

Alberici

et al. 2023

J Nephrol

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As the global burden of chronic kidney disease continues to increase, the use of peritoneal dialysis is often advocated as the preferred initial dialysis modality. Observational studies suggest a survival advantage for peritoneal dialysis over hemodialysis for the initial 2–3 years of dialysis. Peritoneal dialysis has been associated with better graft survival after kidney transplantation and has a reduced cost burden compared to hemodialysis. However, several medical and non-medical reasons may limit access to peritoneal dialysis, and less than 20% of patients with end-stage kidney disease are treated with peritoneal dialysis worldwide. In this narrative review, we sought to summarize the recent medical literature on risk factors for peritoneal dialysis discontinuation, distinguishing the early and the late phase after peritoneal dialysis initiation. Although the definition of clinically relevant outcomes varies among studies, we observed that center size, older age, and the presence of many comorbidities are risk factors associated with peritoneal dialysis discontinuation, regardless of the phase after peritoneal dialysis initiation. On the contrary, poor technique training and late referral to nephrology care, as opposed to the need for a caregiver, patient burnout and frequent hospitalizations, are related to early and late peritoneal dialysis drop-out, respectively. The aim of the review is to provide an overview of the most relevant parameters to be considered when advising patients in the selection of the most appropriate dialysis modality and in the clinical management of peritoneal dialysis patients. In addition, we wish to provide the readers with a critical appraisal of current literature and a call for a consensus on the definition of clinically relevant outcomes in peritoneal dialysis to better address patients' needs. Graphical abstract

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Incidence and Risk Factors Associated with Technique Failure in the First Year of Peritoneal Dialysis: A Single Center Retrospective Cohort Study in Southern China

Dong

et al. 2022

BMC Nephrol

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Background Technique failure is more likely to occur during the first 12 months after peritoneal dialysis (PD) initiation, which is a great challenge encountered in PD patients. The aim of this study was to investigate the incidence and risk factors associated with technique failure within the first year of PD patients in Southern China. Methods Incident PD patients who were followed up for at least one year at The First Affiliated Hospital of Sun Yat-sen University from January 1, 2006 to December 31, 2015 were included. Technique failure was defined as transferring to hemodialysis (HD) for more than 30 days or death within the first year after start of PD. A competitive risk regression analysis was used to explore the incidence and risk factors of the technique failure. Results Overall, 2,290 incident PD patients were included in this study, with a mean age of 48.2 ± 15.7 years, 40.9% female and 25.2% with diabetes. A total of 173 patients (7.5%) had technique failure during the first year of PD. Among them, the patient death account for 62.4% (n = 108) and transferring to HD account for 37.6% (n = 65). The main reasons for death were cardiovascular diseases (n = 32, 29.6%), infection (n = 15, 13.8%) and for conversion to HD were mechanical cause (n = 28, 43.1%), infection cause (n = 22, 33.8%). The risk factors for the technique failure included advanced age (HR 2.78, 95%CI 1.82–4.30), low body mass index (BMI < 18.5 kg/m2: HR 1.77, 95%CI 1.17–2.67), history of congestive heart failure (HR 2.81, 95%CI 1.58–4.98), or time on HD before PD ≤ 3 months (HR 1.49, 95%CI 1.05–2.10), peritonitis (HR 2.02, 95%CI 1.36–3.01);while higher serum albumin (HR 0.93, 95%CI 0.89–0.96) and using employee medical insurance to pay expenses (HR 0.47, 95%CI 0.32–0.69) were associated with reduced risk. Conclusions Advanced age, poor nutritional status, history of HD or congestive heart failure, and peritonitis are related factors that increase the risk of technique failure in the first year of PD, while patients' type of medical insurance may also have an influence on early technique failure.

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Early technique failure in peritoneal dialysis patients in a multi-ethnic Asian country

Cited by 3 publications

References 19 publications

Incidence and Risk Factors Associated with Technique Failure in the First Year of Peritoneal Dialysis: A Single Center Retrospective Cohort Study in Southern China

Incidence and Risk Factors Associated with Technique Failure in the First Year of Peritoneal Dialysis: A Single Center Retrospective Cohort Study in Southern China

Peritoneal dialysis discontinuation: to the root of the problem

Incidence and Risk Factors Associated with Technique Failure in the First Year of Peritoneal Dialysis: A Single Center Retrospective Cohort Study in Southern China

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