JHC CHEN1,2, DW JOHNSON3,4, C HAWLEY3,4, N BOUDVILLE5,6, WH LIM6
1Department of Nephrology, Prince of Wales Hospital, Sydney, New South Wales; 2School of Medicine, University of New South Wales, Sydney, New South Wales; 3Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland; 4Translational Research Institute, Brisbane, Queensland; 5School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia; 6Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia
Aim: We aim to examine the association between causes of peritoneal dialysis (PD) technique failure and all-cause and cause-specific mortality.
Background: PD technique failure occurs in almost 25% of incident patients with end-stage kidney disease, with infection and inadequate dialysis the most common causes. However, the association between causes of PD technique failure and mortality remains unknown.
Methods: Using data from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) between 1989 and 2014, we assessed the mortality rates and association between the four most common causes of PD technique failure using adjusted Cox proportional hazard models. There was a violation of proportional hazard assumption; therefore, follow-up periods following PD technique failure were separated to 0-2 years, >2-5 years and >5 years.
Results: Of the 4663 incident PD patients, 2415 (51.8%), 883 (18.9%), 836 (17.9%) and 529 (11.3%) patients experienced PD technique failure (and transferred to haemodialysis) attributed to infection, inadequate dialysis, mechanical failure and social reasons respectively. Within the first 2 years post-technique failure, compared to patients who experienced infectionrelated technique failure, the adjusted hazard ratio (HR) of patients with inadequate dialysis was 0.84 (95%CI 0.71-0.99), 0.78 (95%CI 0.66-0.93) for mechanical failure and 1.43 (95%CI 1.22-1.69) for social reasons. There was an excess of withdrawal- and infection-related mortality in patients with infection-related technique failure. Beyond 2-years post-technique failure, there were no differences in all-cause and cause-specific mortality rates between the causes of PD technique failure.
Conclusions: PD technique failure secondary to infection and social reasons were associated with a higher hazard of early mortality, but this survival disadvantage was not apparent beyond 2-years post-technique failure.