Study: Identification of Risk Factors for Peritoneal Dialysis Modality Failure

Among patients with end stage kidney disease (ESKD), treatment with peritoneal dialysis (PD) is associated with better quality of life and clinical outcomes compared with in-center hemodialysis (ICHD). However, some patients who initiate PD may later fail the modality and switch to ICHD. Clinical and non-clinical factors may contribute to modality failure. Targeted interventions that address such factors may enable retention of patients on PD. A recent analysis conducted by DaVita’s Patient Safety Organization with the assistance of DaVita Clinical Research sought to identify factors that are associated with greater risk of PD modality failure.

Patients included in the study were adults (≥ 18 years old) who were either prevalent on PD or initiated PD between 01 January 2014 and 31 December 2016. Index event was defined as the first of at least 3 consecutive non-training PD treatments during the study period. Follow-up began on the first day of the month following index and continued until the earliest of study end (31 July 2017), censoring (transplant, death, or loss to follow-up), modality change (transition from PD to home HD), or modality failure (transition from PD to ICHD). Factors associated with PD modality failure were identified using Cox regression models.

The following factors examined in the analysis were found to be associated with PD modality failure:

• Fluid- and/or solute-related factors: body weight, body weight change, serum albumin, change in serum albumin, and dialysis adequacy (Kt/V)
• Treatment burden-related factors: treatment type (continuous ambulatory vs. continuous cycling PD), daily exchange volume, receipt of retraining sessions, an indication of the need for support during treatment, and distance to the treatment center
• Peritonitis-related factors: hospital admission, performance of a peritoneal culture, detection of gram-negative rods in the peritoneal fluid, and prescription of antibiotics
• Facility-related factors: the number of ICHD chairs available at the facility and the number of patients treated

The factors with the most prominent associations with PD modality failure were the need for support during treatment, low Kt/V, low albumin, hospital admission—all-cause and fluid-related, and the need for antibiotics and/or peritoneal fluid culture. Each of these factors was associated with at least a doubling of risk of modality failure.

For more information, read the research poster (which was presented at the American Society of Nephrology’s annual meeting in 2018), here.