Predictors and outcomes of patients switching from maintenance haemodialysis to peritoneal dialysis in Australia and New Zealand: Strengthening the argument for ‘peritoneal dialysis first’ policy

Abstract

Aims (1) To determine incidence and reasons for transfer from maintenance haemodialysis (HD) to peritoneal dialysis (PD); (2) To compare mortality of HD patients transferred to PD with those who initiated and remained on PD. Methods A 1:2 matched cohort of ANZDATA included patients dialyzing over 3 months dividing into 2 groups. Group A (HD to PD) was compared to group B (initiated and remained on PD) and matched PD group (Group C). We compared mortality by total time on dialysis regardless of modality. Results Of 20 882 patients, there were 911 in group A. The transfer rate from HD to PD was 5%, 6.7% and 7.4% at 1,4 and 8 years, respectively. Median time before switching of patients in Group A was 5.9 (4.0–10.9) months. The commonest reported reason for transfer was patient preference (63.8%). Mortality was significantly worse in Group A if dialysis vintage was ≤6 months and from 12–24 months (P < 0.05), whereas there was no difference in mortality if dialysis vintage was 6–12 months or ≥ 24 months (P = 0.073 and P = 0.153, respectively). Overall, mortality of patients in group A was higher than that in group B after adjusting for age, race, chronic lung disease, peripheral vascular disease, cerebrovascular disease, diabetes, haemoglobin and phosphate (hazard ratio = 1.335, 95% confidence interval = 1.172–1.520). Conclusion Haemodialysis patients transferred to PD had higher mortality than those initiated on PD, strengthening the case for PD first policy.

Prevalence and risk factors of peripheral artery disease in a population with chronic kidney disease in Australia: A systematic review and meta‐analysis

“…This review collected persons who underwent new dialysis from 1992 to 2018. In which, three sub‐cohorts by Chan et al, 26 Kotwal et al, 27,28 and Pianta et al 29 reported data in Sydney and the other reports 31,36,39–54 provided nationwide data. A study by Wang et al 32 was based on the CKD.QLD registry that collected data of a predialysis population in all public sector renal practises in Queensland since 2011.…”

“…This review collected persons who underwent new dialysis from 1992 to 2018. In which, three sub-cohorts by Chan et al, 26 Kotwal et al, 27,28 and Pianta et al 29 reported data in Sydney and the other reports 31,36,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] provided nationwide data. A study by Wang et al 32 was based on the CKD.…”

Albumin-globulin ratio and mortality in patients on peritoneal dialysis: a retrospective study

“…After a period on HD, most patients lose their residual renal function (RRF) and in these adequate solute clearances and ultrafiltration could be difficult to achieve with PD. Additionally, patients who transferred from HD to PD had a higher rate of peritonitis, PD technique failure, and death [43,44]. The association between AGR and patient's survival on HD needs to be explored in the future.…”

Dialysis Reimbursement: What Impact Do Different Models Have on Clinical Choices?

“…Even if “peritoneal dialysis first” or “home haemodialysis first” probably represents a winning strategy for patients (more autonomy, more empowerment, better care), and for the health care system (lower costs of transportation, lower overall indirect costs and probably also lower costs of direct treatment, especially where PD is non assisted), this strategy is not uniformly developed, partly because of the fact that reimbursement is often lower and the advantage to the individuals and to society is not uniformly accompanied by an advantage to the dialysis providers [103,104,105,106,107].…”