Changes in Outcomes over Time Among Incident Peritoneal Dialysis Patients in Southern China

Abstract

Background:The present study was to investigate the changes in outcomes of incident patients who started peritoneal dialysis (PD) between 2006 - 2010 and 2011 - 2015 in Southern China.Methods:In this single-center cohort study, incident PD patients from January 1, 2006, to December 31, 2015, were enrolled. Collected data included baseline demographic, clinical, biochemical characteristics, and outcomes. Patients who initiated PD during 2006 - 2010 and 2011 - 2015 were followed up until December 31, 2011, and December 31, 2016, respectively. Peritonitis rate, patient survival, and technique survival were compared between the 2 incident cohorts.Results:A total of 2,021 incident PD patients were enrolled, with a mean age of 47.2 ± 15.2 years, 40.6% female. Compared with the 2006 - 2010 cohort (n = 1,073), patients initiating PD during 2011 - 2015 (n = 948) were younger (46.2 ± 14.8 vs 48.1 ± 15.5 years, p = 0.006), had similar baseline estimate glomerular filtration rate (eGFR) (5.81 ± 2.41 vs 5.81 ± 2.89 mL/min/1.73 m², p = 0.109) and comparable percentage of diabetes mellitus (24.9% vs 25.7%, p = 0.682). The overall peritonitis rate in the 2011 - 2015 cohort was lower than in the 2006 - 2010 cohort (0.158 vs 0.161 episodes per year, p = 0.001). At the end of 1, 3, and 5 years, the 2006 - 2010 and 2011 - 2015 cohorts had patient survival rates of 94%, 82%, 64%, and 97%, 87%, 74%, respectively (p < 0.001). After multivariable adjustment, patients starting PD in 2011 - 2015 were associated with lower risk of all-cause mortality (hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.60 - 0.98). In gender and age-stratified models, male patients had a significantly lower risk of all-cause mortality (HR 0.58, 95% CI 0.41 - 0.83), and patients with age < 65 years showed a significantly lower risk of cardiovascular (CV) mortality (HR 0.63, 95% CI 0.40 - 0.99) in 2011 - 2015 compared with 2006 - 2010. The death-censored technique survival rates were not significantly different between the 2 cohorts (p = 0.234).Conclusion:Peritonitis rates and patient survival on PD continue to improve. Patients initiating PD between 2011 and 2015 were associated with better outcomes.

Keywords: End-stage kidney disease; patient survival; peritonitis; technique survival.