Patient-related and centre-related factors influencing technique survival of peritoneal dialysis in The Netherlands

Abstract

Background: Although technique failure occurs relatively frequently in peritoneal dialysis (PD), few data have been published on differences in technique failure between centres.

Methods: Using data from RENINE, the comprehensive dialysis registry of The Netherlands, we analysed PD technique failure rates in the period 1994-1999, with life table methods and Cox multiple regression analysis. Patient age, sex, and the presence or absence of diabetes were included in the analysis, as well as time of initiation of PD and the following centre characteristics: number of PD patients treated in the centre and percentage of patients on PD.

Results: Technique failure was higher in older patients: 2-year technique survival was 75% in those younger than 45 years, 68% in the group aged 45-64 years, and 60% in those over 64 years (P<0.0001). Sex and diabetes made no difference in technique survival. Mean annual technique failure rates varied greatly between centres (10-59%) and correlated with the number of patients on PD in the centre (r=-0.396, P=0.009) and with the fraction of patients on PD (r=-0.410, P=0.006). Low technique survival rates occurred mainly in centres with less than 20 patients on PD: relative risk for technique failure 1.68 as compared with larger centres. Patients starting PD in the period 1997-1999 had better technique survival than those starting in 1994-1996 (P=0.001).

Conclusion: PD technique survival in The Netherlands has increased in recent years. Having less than 20 PD patients in a centre or having a small fraction of patients on PD carries an increased risk of technique failure. The variability in PD technique survival between centres indicates that in many centres further improvements should be possible.