Unplanned peritoneal dialysis (PD) and patient survival under Thailand “PD first” policy

Phannajit, Jeerath; Kanjanabuch, Talerngsak; Ponpirul, Krit; Narenpitak, Surapong; Puapatanakul, Pongpratch; Johnson, David W.; Halue, Guttiga; Lorvinidnun, Pichet; Tangjittrong, Kittisak; Boonyakrai, Chanchana; Tatiyanupanwong, Sajja; Purisinsith, Sirirat; Chieochanthanakij, Rutchanee; Treamtrakanpon, Worapot; Parinyasiri, Uraiwan; Lounseng, Niwat; Songviriyavithaya, Phichit; Sritippayawan, Suchai; Davies, Simon; Robinson, Bruce M.; Perl, Jeffrey; Tungsanga, Kriang; PDOPPS Steering Committee, on behalf of Thailand

Abstract

Background: There are conflicting results concerning the survival differences between patients with and without hemodialysis (HD) transfer (HDT). Using the Peritoneal Dialysis (PD) Outcomes and Practice Patterns Study (PDOPPS), a prospective cohort study of randomly selected patients across national samples of PD facilities, we estimated the survival and the relative mortality hazard for PD patients according to real-life PD initiation practices in Thailand.

Methods: PD patients from 22 PD centers in Thailand were prospectively followed in the PDOPPS during May 2016-Nov 2019 and were categorized into 4 groups: 1) PD only; 2) HD transferred to PD; 3) PD with HDT; and, 4) PD with initial temporary HD (reflecting unplanned dialysis). HDT was defined as no return to PD from HD therapy within12 weeks of transferring to HD. After 25 cases were excluded because of unknown patient survival, 848 patients were included. Comparison of continuous variables among the four groups of patients used one-way ANOVA while the comparison of categorical variables used the Chi-square test. A multivariable Cox proportional hazard model regression adjusted by age, gender, body mass index, educational level, kidney failure vintage, and comorbidities (diabetes and cardiovascular disease) was used to estimate associations between modality subgroups and patient survival.

Results: Overall, 31% of the PD patients (262 cases) died during follow-up. Compared to the other groups, PD with initial HD was significantly more frequent in patients with lower educational attainment and shorter kidney failure vintage. This group had the lowest eGFR levels at the beginning of dialysis and were less frequent, belonging to the PD centers with larger PD populations (≥ 100 cases), longer PD experience (>10 years), greater nephrologist availability, and urban locations. PD with initial HD was associated with an increased risk of death (HR=1.56, 95%CI, 1.08-2.24). Kaplan Meier curves for patient survival in all groups of patients are demonstrated in Figure 1.

Conclusion: Unplanned PD is associated with worse survival and is more frequently associated with lower educational attainment, shorter kidney failure vintage, lower eGFR and treatment in smaller PD units with shorter PD experience, poorer nephrologist availability, and rural locations. This warrants further investigation to identify effective interventions to mitigate the risk of unplanned dialysis.

Citation

Phannajit, J., Kanjanabuch, T., Ponpirul, K., Narenpitak, S., Puapatanakul, P., Johnson, D. W., …PDOPPS Steering Committee, O. B. O. T. (2021, August). Unplanned peritoneal dialysis (PD) and patient survival under Thailand “PD first” policy. Presented at 19th Asian Pacific Congress of Nephrology, Virtual Congress

• Presentation Conference Type: Speech
• Conference Name: 19th Asian Pacific Congress of Nephrology
• Conference Location: Virtual Congress
• Start Date: Aug 19, 2021
• End Date: Aug 22, 2021
• Deposit Date: Jun 28, 2023
• Publisher URL: https://onlinelibrary.wiley.com/doi/10.1111/nep.13943