Study looks at use, time on PD worldwide
A recently published study looking at the use of peritoneal dialysis around the world found that countries with higher rates of kidney transplantation also had patients with the shortest time on PD.
Data for the study were gathered from the Peritoneal Dialysis Practice Patterns Study (PDOPPS), a project looking at utilization and outcomes from PD in multiple countries, including the United States.
Researchers also found that infection, chiefly peritonitis, was a leading cause for patients to transfer to hemodialysis from PD.
“In this large-scale, multinational comparison of key clinical outcomes for patients on PD, we quantified an overall median time on PD of 2.3 years with wide observed variability across countries, mostly driven by differences in kidney transplantation,” Mark Lambie, MD, of the Medicine and Health Sciences Department at Keele University, Keele, United Kingdom, and colleagues wrote in reviewing the study findings. “Modest differences in mortality was evident after adjusting for patient case mix, with smaller differences in [hemodialysis] HD transfer.”
The authors looked at PDOPPS data from 218 randomly selected facilities that offer PD (n = 7,121 patients) in Australia/New Zealand, Canada, Japan, Thailand, the United Kingdom and the United States. “We calculated the cumulative incidence from peritoneal dialysis start to hemodialysis transfer, death or kidney transplantation over 5 years and adjusted hazard ratios for patient and facility factors associated with death and hemodialysis transfer,” the authors wrote.
Causes of HD transfer
Researchers identified several reasons why patients experiencing failure on PD, and some of the issues developed at early onset. “Catheter problems, leaks, and hernia were important causes for HD transfer early in PD therapy and became proportionally less common,” the researchers wrote. “Poor water or solute clearance and psychosocial/medical reasons became more common with increasing PD vintage,” they wrote.
A higher BMI for patients in the PDOPPS was also associated with a higher risk of HD transfer. “Previous studies have yielded inconsistent findings, but differences across studies may reflect the different BMI cutoffs used, populations studied and definitions of HD transfer used,” the authors wrote.
The size of a PD program had no influence on the risk of failure on PD and the transfer to hemodialysis, the researchers reported. “We found no consistent relationship between PD facility size and the risk of HD transfer. In countries such as the United States, the majority of facilities treat [fewer than] 20 patients, but to ascribe practices at a facility to outcomes, the PDOPPS sample required a minimum number of 20 patients on PD per facility for study participation.
“These results should be exercised with caution because it is possible that all PDOPPS clinic sizes may have been above a critical threshold, whereby no relationship exists between size and outcomes,” they wrote.
Time on dialysis
In Thailand, the median time for patients on PD was 2.8 years. “That was longer than that seen for the United Kingdom, but most Thai patients no longer receiving PD 3.5 years after the PD start [patients] had died.
“One can expect that the same issues in making meaningful international comparisons regarding time on PD can also exist across facilities within a country,” the authors wrote, acknowledging in the paper that it was difficult to draw country-to-country comparisons.
“PD is associated with similar survival compared with facility-based hemodialysis (HD),” the researchers wrote. “Compared with patients on HD, patients receiving PD experience superior treatment satisfaction, longer preservation of residual kidney function and, often, lower annualized treatment costs,” they wrote. “Increasing PD utilization is limited by the shortened treatment time on PD as compared with facility-based HD. A transition from PD to HD is costly, and it is a period of high morbidity and impaired quality of life,” they wrote.