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Variation in Peritoneal Dialysis Time on Therapy by Country: Results from the Peritoneal Dialysis Outcomes and Practice Patterns Study.

Lambie, Mark; Zhao, Junhui; McCullough, Keith; Davies, Simon J.; Kawanishi, Hideki; Johnson, David W.; Sloand, James A.; Sanabria, Mauricio; Kanjanabuch, Talerngsak; Kim, Yong-Lim; Shen, Jenny I.; Pisoni, Ronald L.; Robinson, Bruce M.; Perl, Jeffrey


Junhui Zhao

Keith McCullough

Hideki Kawanishi

David W. Johnson

James A. Sloand

Mauricio Sanabria

Talerngsak Kanjanabuch

Yong-Lim Kim

Jenny I. Shen

Ronald L. Pisoni

Bruce M. Robinson

Jeffrey Perl


Background and objectives Quantifying contemporary peritoneal dialysis time on therapy is important for patients and providers. We describe time on peritoneal dialysis in the context of outcomes of hemodialysis transfer, death, and kidney transplantation on the basis of the multinational, observational Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) from 2014 to 2017. Design, setting, participants, & measurements Among 218 randomly selected peritoneal dialysis facilities (7121 patients) in the PDOPPS from Australia/New Zealand, Canada, Japan, Thailand, the United Kingdom, and the United States, we calculated the cumulative incidence from peritoneal dialysis start to hemodialysis transfer, death, or kidney transplantation over 5 years and adjusted hazard ratios for patient and facility factors associated with death and hemodialysis transfer. Results Median time on peritoneal dialysis ranged from 1.7 (interquartile range, 0.8–2.9; the United Kingdom) to 3.2 (interquartile range, 1.5–6.0; Japan) years and was longer with lower kidney transplantation rates (range: 32% [the United Kingdom] to 2% [Japan and Thailand] over 3 years). Adjusted hemodialysis transfer risk was lowest in Thailand, but death risk was higher in Thailand and the United States compared with most countries. Infection was the leading cause of hemodialysis transfer, with higher hemodialysis transfer risks seen in patients having psychiatric disorder history or elevated body mass index. The proportion of patients with total weekly Kt/V ≥1.7 at a facility was not associated with death or hemodialysis transfer. Conclusions Countries in the PDOPPS with higher rates of kidney transplantation tended to have shorter median times on peritoneal dialysis. Identification of infection as a leading cause of hemodialysis transfer and patient and facility factors associated with the risk of hemodialysis transfer can facilitate interventions to reduce these events. Podcast This article contains a podcast at

Journal Article Type Article
Acceptance Date Apr 13, 2022
Online Publication Date Jul 21, 2023
Publication Date May 31, 2022
Journal Clinical Journal of the American Society of Nephrology
Print ISSN 1555-9041
Publisher American Society of Nephrology
Volume 17
Issue 6
Pages 861-871
Keywords peritoneal dialysis; hemodialysis; kidney transplantation
Publisher URL