Duration of Hemodialysis Following Peritoneal Dialysis Cessation in Australia and New Zealand: Proposal for a Standardized Definition of Technique Failure

Abstract

♦ BACKGROUND: Although technique failure is a key outcome in peritoneal dialysis (PD), there is currently no agreement on a uniform definition. We explored different definitions of PD technique failure using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. ♦ METHODS: We included 16,612 incident PD patients in Australia and New Zealand from January 1998 to December 2012. Different definitions of technique failure were applied according to the minimum number of days (30, 60, 90, 180, or 365) the patient received hemodialysis after cessation of PD. ♦ RESULTS: Median technique survival varied from 2.0 years with the 30-day definition to 2.4 years with the 365-day definition. For all definitions, the most common causes of technique failure were death, followed by infectious complications. The likelihood of a patient returning to PD within 12 months of technique failure was highest in the 30-day definition (24%), and was very small when using the 180- and 365-day definitions (3% and 0.8%, respectively). Patients whose technique failed due to mechanical reasons were the most likely to return to PD (46% within 12 months using the 30-day definition). ♦ CONCLUSIONS: Both 30- and 180-day definitions have clinical relevance but offer different perspectives with very different prognostic implications for further PD. Therefore, we propose that PD technique failure be defined by a composite endpoint of death or transfer to hemodialysis using both 30-day and 180-day definitions.

Keywords: Hemodialysis; peritoneal dialysis; standardized definition; technique failure.

Figure 1 —

PD technique survival after technique failure according to definition. The graph shows PD technique survival according to the different definitions of technique failure. PD = peritoneal dialysis; HD = hemodialysis.

Figure 2 —

Causes of PD technique failure for 30-day and 180-day definitions. The graphs show the contribution of each of the causes of technique failure for the 30- and 180-day definitions over time. PD = peritoneal dialysis; HD = hemodialysis; NZ = New Zealand; EPS = encapsulating peritoneal sclerosis.

Figure 3 —

Time to restarting PD after technique failure by definition. The graph shows the likelihood of patients returning to PD within 12 months according to the different definitions. Technique failure starts once the criterion for PD technique failure is reached (e.g. after 30 days on HD for the 30-day definition). PD = peritoneal dialysis; HD = hemodialysis.