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. 2025 Apr 1;6(4):583-594.
doi: 10.34067/KID.0000000732. Epub 2025 Feb 7.

Patient on Peritoneal Dialysis Transfers to Hemodialysis: Causes and Associated Risks

Nanti E Adoukonou  1 , Annabel Boyer  2   3 , Thierry Lobbedez  1   2   3 , Clémence Bechade  1   2   3 , Antoine Lanot  1   2   3
Affiliations

Patient on Peritoneal Dialysis Transfers to Hemodialysis: Causes and Associated Risks

Nanti E Adoukonou et al. Kidney360. .

Abstract

Key Points:

  1. Nurse assistance is associated with a lower risk of transfer to hemodialysis for dialysis inadequacy after 6 months and for infection in the first 18 months.

  2. Compared with automated peritoneal dialysis (PD), continuous ambulatory PD is associated with a higher risk of transfer to hemodialysis for mechanical issue during the first 18 months.

  3. Suboptimal starters have a higher risk of transfer to hemodialysis due to psychosocial challenges in the first 6 months of PD.

Background: The end of peritoneal dialysis (PD) can be marked by kidney transplantation, death, or transfer to hemodialysis. We compared the risks of the different reasons for transfer to hemodialysis in patients on PD according to the use of assistance for PD care, PD modality, and the suboptimal starter status.

Methods: This was a retrospective study using data from the French Language PD Registry from patients who started PD between January 1, 2002, and December 31, 2018. We used Cox and Fine–Gray survival models to evaluate the risks of transfer to hemodialysis due to PD inadequacy, infection, mechanical issue, psychosocial issue, other PD-related causes, and other non–PD-related causes. Models were evaluated for three periods of PD vintage: 0–6 months, 6–18 months, and after 18 months.

Results: The study included 15,974 patients on incident PD treated in 170 French PD units. There were 6835 deaths, 5108 transfers to hemodialysis, and 3092 renal transplantations. Nurse-assisted PD was associated with a lower risk of transfer to hemodialysis for infection in the first 18 months (cause-specific hazard ratio [cs-HR], 0.51; 95% confidence interval [CI], 0.31 to 0.83 before 6 months) and for adequacy issues after 6 months (cs-HR, 0.59; 95% CI, 0.51 to 0.70 after 18 months). The risk of transfer for mechanical issue was higher in continuous ambulatory PD compared with automated PD during the first 18 months (cs-HR, 1.41; 95% CI, 1.00 to 1.99 before 6 months), but continuous ambulatory PD was associated with a lower risk of adequacy, infectious, or mechanical issue after 18 months. Finally, suboptimal starters have a higher risk of transfer due to psychosocial challenges in the first 6 months (cs-HR, 1.70; 95% CI, 1.03 to 2.81).

Conclusions: Distinct factors are associated with the risk of transfer from PD to in-center hemodialysis, according to the cause of the transfer. Some preventive measures targeting these risk factors may help to maintain patients in PD.

Podcast: This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/K360/2025_03_27_KID0000000732.mp3

Keywords: ESKD; clinical epidemiology; dialysis; dialysis access; dialysis volume; epidemiology and outcomes; peritoneal dialysis.

PubMed Disclaimer

Conflict of interest statement

Disclosure forms, as provided by each author, are available with the online version of the article at http://links.lww.com/KN9/A903.

Figures

None
Graphical abstract
Figure 1
Figure 1
Cumulative incidence for PD cessation and its causes over time. (A) Cumulative incidence functions for the four causes of PD cessation. (B) Cumulative incidence functions for the six causes of transfer to hemodialysis. The three PD vintage periods are shown in different colors (<6 months, 6–18 months, and more than 18 months). HD, hemodialysis; PD, peritoneal dialysis.
Figure 2
Figure 2
Flow chart. RDPLF, French Language Peritoneal Dialysis Registry.
Figure 3
Figure 3
Estimates from the Cox and Fine–Gray models for risk of transfer to hemodialysis due to inadequate dialysis. Survival models adjusted on age, sex, diabetes, CCI, and center size. APD, automated peritoneal dialysis; CCI, Charlson Comorbidity Index; CI, confidence interval; cs-HR: cause-specific hazard ratio; sd-HR, subdistribution hazard ratio.
Figure 4
Figure 4
Estimates from the Cox and Fine–Gray models for risk of transfer to hemodialysis due to psychosocial causes. Survival models adjusted on age, sex, diabetes, CCI, and center size.
Figure 5
Figure 5
Estimates from the Cox and Fine–Gray models for risk of transfer to hemodialysis due to infections. Survival models adjusted on age, sex, diabetes, CCI, and center size.
Figure 6
Figure 6
Estimates from the Cox and Fine–Gray models for risk of transfer to hemodialysis due to mechanical issues. Survival models adjusted on age, sex, diabetes, CCI, and center size.
See this image and copyright information in PMC

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