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Increased use of PD not linked with higher rate of transition to hemodialysis in first year
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Even with a near doubling of patients who elected to go on PD in the United States during the last decade, the percent transitioning to hemodialysis – an indication that PD was no longer effective – did not increase in the first year, a study presented here during ASN Kidney Week 2018 showed.
“Conversion from peritoneal dialysis (PD) to hemodialysis (HD) is frequently necessitated by medical complications, including peritonitis and ultrafiltration failure,” wrote Eric Weinhandl, PhD, MS, a clinical epidemiologist at NxStage Medical and an adjunct assistant professor at the University of Minnesota, and colleagues in their abstract. “Conversion can be disruptive to the patient, as it usually involves a transition from dialysis in the home to dialysis in a facility and may require placement of a permanent vascular access. In addition, high rates of conversion impose stress on dialysis providers, as high rates necessitate additional training in order to maintain program size.”
The researchers analyzed data from the United States Renal System to assess rates of conversion from PD to in-center HD among U.S. incident patients between 2006 and 2015. Patients were selected that initiated PD within 3 months after dialysis initiation. “We followed patients from first date of PD until the earliest of conversion to HD (defined as treatment with HD for 2 months), death, kidney transplant, or recovery of renal function, but for a maximum of 1 year,” they wrote.
In the 2008 cohort, the number of incident patients on PD was 7,924; that increased to 14,273 in the 2015 cohort. Mean age increased slightly during the study era, reaching 59 years in the 2015 cohort.
“The rate of conversion from PD to HD was 20.8 events per 100 patient-years in the 2006 cohort and reached a low of 17.6 events per 100 patient-years in three subsequent cohorts: 2010, 2013 and 2015. The hazard ratios of conversion from PD to HD were 1.10 (P < 0.001) in both the 2006 to 2007 and 2008 to 2009 cohorts and 0.99 (P > 0.5) in both the 2012-2013 and 2014 to 2015 cohorts.
“Although the number of incident patients on PD grew every year from 2008 to 2015, the rate of conversion from PD to HD during the first year after initiation of PD was essentially unchanged between 2010 and 2015,” the authors concluded.
Reference:
Weinhandl E. et al. Abstract: TH-PO392. Presented at: ASN Kidney Week; Oct. 23-28, 2018; San Diego.
Disclosures: The authors are employed by NxStage Medical.