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- Title
Predictors and outcomes of patients switching from maintenance haemodialysis to peritoneal dialysis in Australia and New Zealand: Strengthening the argument for 'peritoneal dialysis first' policy.
- Authors
Nguyen, Anh N. L.; Prasad Kafle, Mukunda; Sud, Kamal; Lee, Vincent W
- Abstract
Aims: (1) To determine incidence and reasons for transfer from maintenance haemodialysis (HD) to peritoneal dialysis (PD); (2) To compare mortality of HD patients transferred to PD with those who initiated and remained on PD. Methods: A 1:2 matched cohort of ANZDATA included patients dialyzing over 3 months dividing into 2 groups. Group A (HD to PD) was compared to group B (initiated and remained on PD) and matched PD group (Group C). We compared mortality by total time on dialysis regardless of modality. Results: Of 20 882 patients, there were 911 in group A. The transfer rate from HD to PD was 5%, 6.7% and 7.4% at 1,4 and 8 years, respectively. Median time before switching of patients in Group A was 5.9 (4.0–10.9) months. The commonest reported reason for transfer was patient preference (63.8%). Mortality was significantly worse in Group A if dialysis vintage was ≤6 months and from 12–24 months (P < 0.05), whereas there was no difference in mortality if dialysis vintage was 6–12 months or ≥ 24 months (P = 0.073 and P = 0.153, respectively). Overall, mortality of patients in group A was higher than that in group B after adjusting for age, race, chronic lung disease, peripheral vascular disease, cerebrovascular disease, diabetes, haemoglobin and phosphate (hazard ratio = 1.335, 95% confidence interval = 1.172–1.520). Conclusion: Haemodialysis patients transferred to PD had higher mortality than those initiated on PD, strengthening the case for PD first policy. SUMMARY AT A GLANCE: In this matched cohort analysis, patients who were started on peritoneal dialysis had better survival than patients who were transferred from haemodialysis to peritoneal dialysis, even though the average time of conversion was around 6 months after dialysis and the major reason of conversion was patient preference. These findings lend support to the PD‐first policy.
- Subjects
NEW Zealand; AUSTRALIA; CEREBROVASCULAR disease; PERITONEAL dialysis; PERIPHERAL vascular diseases; CHRONIC kidney failure; ARGUMENT
- Publication
Nephrology, 2019, Vol 24, Issue 9, p958
- ISSN
1320-5358
- Publication type
Article
- DOI
10.1111/nep.13512