Mortality Trends After Transfer From Peritoneal Dialysis to Hemodialysis

Abstract

Introduction: Transition to hemodialysis (HD) is a common outcome in peritoneal dialysis (PD), but the associated mortality risk is poorly understood. This study sought to identify rates of and risk factors for mortality after transitioning from PD to HD.

Methods: Patients with incident PD (between 2000 and 2014) who transferred to HD for ≥1 day were identified, using data from Australia and New Zealand Dialysis and Transplantation registry (ANZDATA), Canadian Organ Replacement Register (CORR), Europe Renal Association (ERA) Registry, and the United States Renal Dialysis System (USRDS). Crude mortality rates were calculated for the first 180 days after transfer. Separate multivariable Cox models were built for early (<90 days), medium (90-180 days), and late (>180 days) periods after transfer.

Results: Overall, 6683, 5847, 21,574, and 80,459 patients were included from ANZDATA, CORR, ERA Registry, and USRDS, respectively. In all registries, crude mortality rate was highest during the first 30 days after a transfer to HD declining thereafter to nadir at 4 to 6 months. Crude mortality rates were lower for patients transferring in the most recent years (than earlier). Older age, PD initiation in earlier cohorts, and longer PD vintage were associated with increased risk of death, with the strongest associations during the first 90 days after transfer and attenuating thereafter. Mortality risk was lower for men than women <90 days after transfer, but higher after 180 days.

Conclusion: In this multinational study, mortality was highest in the first month after a transfer from PD to HD and risk factors varied by time period after transfer. This study highlights the vulnerability of patients at the time of modality transfer and the need to improve transitions.

Keywords: hemodialysis; peritoneal dialysis; survival; technique failure; transition.

Graphical abstract

Figure 1

Crude mortality rates after a transfer from PD to HD (a) per 30-day period for 180 days post-transfer and (b) per 5-day period within the first 30 days post-transfer. HD, hemodialysis; PD, peritoneal dialysis; PY, person year.

Figure 2

Crude mortality rates by year of RRT initiation (2000–2004/2005–2009/2010–2014), by registry (a) ANZDATA, (b) CORR, (c) ERA Registry, and (d) USRDS. ANZDATA, Australia and New Zealand Dialysis and Transplantation registry; CORR, Canadian Organ Replacement Register; ERA, Europe Renal Association Registry; PY, person year; RRT, renal replacement therapies; USRDS, United States Renal Dialysis System databases.

Figure 3

Crude age-stratified mortality rates after transfer from PD to HD per 30-day periods in (a) ANZDATA, (b) CORR, (c) ERA Registry, and (d) USRDS. ANZDATA, Australia and New Zealand Dialysis and Transplantation registry; CORR, Canadian Organ Replacement Register; ERA, Europe Renal Association Registry; HD, hemodialysis; PD, peritoneal dialysis; PY, person year; USRDS, United States Renal Dialysis System databases.

Figure 4

Crude mortality rates after transfer from PD to HD per 30-day periods stratified by PD vintage before transfer, in (a) ANZDATA, (b) CORR, (c) ERA Registry, and (d) USRDS. ANZDATA, Australia and New Zealand Dialysis and Transplantation registry; CORR, Canadian Organ Replacement Register; ERA, Europe Renal Association Registry; HD, hemodialysis; PD, peritoneal dialysis; PY, person year; USRDS, United States Renal Dialysis System databases.

Figure 5

Meta-analysis with adjusted hazard ratios for mortality by (a) age groups, (b) male sex, (c) cohort years, and (d) peritoneal dialysis vintage during early (<90 days), medium (90–180 days), and late (>180 days) periods post-transfer from PD to HD. Reference groups: age <50 years, female, years 2000 to 2004, PD vintage <6 months. Adjusted for age, sex, primary kidney disease, year of kidney replacement therapy initiation, and duration of PD before transfer to HD. HD, hemodialysis; HR, hazard ratio; PD, peritoneal dialysis.