Outcome of Hemodialysis Patients Who Had Failed Peritoneal Dialysis

Abstract

Background: Peritoneal dialysis (PD) and hemodialysis (HD) are often regarded as equivalent choices of renal replacement therapy. However, little is known about the outcome of patients who failed PD and converted to long-term HD. Methods: We reviewed 197 patients who received long-term HD after failed PD in a University hospital from 1994 to 2008 (the PD-first group) and 140 patients who received long-term HD as their initial therapy during that period (the primary-HD group). Their survival rates are compared. Results: The two groups are highly comparable in terms of baseline demographic data. The PD-first group required more temporary dialysis catheters than the primary-HD group (3.1 ± 3.4 vs. 1.5 ± 1.8, p < 0.0001). At 5 years, the actuarial survival of the PD-first group was significantly lower than that of the primary-HD group (39.9 vs. 59.7%, p < 0.0001), while technique survival was similar (30.4 vs. 30.1%, p = 0.7). When analysis on actuarial survival was performed for patients who survived the first 12 months on HD, the 5-year survival became similar (65.2 vs. 68.8%, p = 0.5). During the first 12 months on HD, independent predictors of actuarial survival of the PD-first group were duration of PD, Charlson’s comorbidity score, type of permanent access and serum albumin before conversion; after 12 months, independent predictors of actuarial survival were Charlson’s comorbidity score, total Kt/V, residual renal function, fat-free edema-free body mass before conversion and baseline peritoneal transport. Conclusion: Patients who were converted to long-term HD after failed PD had a higher mortality than patients who used HD as the primary modality of renal replacement therapy. The excessive mortality, however, was limited to the first 12 months after conversion, and the technique survival was similar between the two groups. Vascular access is a common problem in patients who failed PD.

Outcomes of Peritoneal Dialysis Patients and Switching to Hemodialysis: A Competing Risks Analysis

“…Our results confirm and extend this finding, showing significantly elevated hazard for central venous line-treated patients after PD technique failure in the more homogenous subgroup of PD-first treated patients. Similar results were found for comparison of mortality risk between PD-first and HD-first treated patients (28). However, the comparative outcome of PD patients after technique failure and patients staying on PD with reference to access type has not been reported so far.…”

Is combined peritoneal dialysis and hemodialysis redundant? A nationwide study from Taiwan

“…For patients who transferred from PD to HD, the mortality risk peaked in the first year, which was attributed to infection (recurrent peritonitis/arteriovenous access infection) and cardiovascular events [16]. In our study, combined therapy was associated with a significantly higher peritonitis rate but lower vascular access infection than direct transfer to HD.…”

Would increasing centre volumes improve patient outcomes in peritoneal dialysis? A registry-based cohort and Monte Carlo simulation study

“…Additional limitations are that we did not model volume as a time-varying exposure to avoid endogeneity (whereby patients could contribute to their own volume exposure after initiating peritoneal dialysis); we constrained the HR to be constant over time (despite some evidence to the contrary), 42 meaning that our HRs are nonetheless validly interpreted as averages over the follow-up period; 30 and we assumed that peritonealdialysis patients have the same risk of death and transplantation after transfer to haemodialysis, which the literature supports 43 but not unequivocally. 44 Further work could relax these latter assumptions through alternative modelling approaches, such as patient-level simulation techniques able to combine results from multiple studies. 45 Overall, our findings suggest that patients initiating peritoneal dialysis in high-volume centres have a reduced risk of technique failure without any change in the risk of death but that policies and interventions to increase patients' exposure to high-volume centres in routine care may yield only modest improvements in technique failure.…”