Predictors of transfer to home hemodialysis after peritoneal dialysis completion

Nadeau-Fredette, Annie-Claire, Hawley, Carmel, Pascoe, Elaine, Chan, Christopher T., Leblanc, Martine, Clayton, Philip A., Polkinghorne, Kevan R., Boudville, Neil and Johnson, David W. (2016) Predictors of transfer to home hemodialysis after peritoneal dialysis completion. Peritoneal Dialysis International, 36 5: 547-554. doi:10.3747/pdi.2015.00121


Author Nadeau-Fredette, Annie-Claire
Hawley, Carmel
Pascoe, Elaine
Chan, Christopher T.
Leblanc, Martine
Clayton, Philip A.
Polkinghorne, Kevan R.
Boudville, Neil
Johnson, David W.
Title Predictors of transfer to home hemodialysis after peritoneal dialysis completion
Journal name Peritoneal Dialysis International   Check publisher's open access policy
ISSN 1718-4304
0896-8608
Publication date 2016-09-01
Year available 2016
Sub-type Article (original research)
DOI 10.3747/pdi.2015.00121
Open Access Status Not yet assessed
Volume 36
Issue 5
Start page 547
End page 554
Total pages 8
Place of publication Milton, ON, Canada
Publisher Multimed
Language eng
Subject 2727 Nephrology
Abstract ♦ Background: The aim of the present study was to evaluate the predictors of transfer to home hemodialysis (HHD) after peritoneal dialysis (PD) completion. ♦ Methods: All Australian and New Zealand patients treated with PD on day 90 after initiation of renal replacement therapy between 2000 and 2012 were included. Completion of PD was defined by death, transplantation, or hemodialysis (HD) for 180 days or more. Patients were categorized as “transferred to HHD” if they initiated HHD fewer than 180 days after PD had ended. Multivariable logistic regression was used to evaluate predictors of transfer to HHD in a restricted cohort experiencing PD technique failure; a competing-risks analysis was used in the unrestricted cohort. ♦ Results: Of 10 710 incident PD patients, 3752 died, 1549 underwent transplantation, and 2915 transferred to HD, among whom 156 (5.4%) started HHD. The positive predictors of transfer to HHD in the restricted cohort were male sex [odds ratio (OR): 2.81], obesity (OR: 2.20), and PD therapy duration (OR: 1.10 per year). Negative predictors included age (OR: 0.95 per year), infectious cause of technique failure (OR: 0.48), underweight (OR: 0.50), kidney disease resulting from hypertension (OR: 0.38) or diabetes (OR: 0.32), race being Maori (OR: 0.65) or Aboriginal and Torres Strait Islander (OR: 0.30). Comparable results were obtained with a competing-risks model. ♦ Conclusions: Transfer to HHD after completion of PD is rare and predicted by patient characteristics at baseline and at the time of PD end. Transition to HHD should be considered more often in patients using PD, especially when they fulfill the identified characteristics.
Formatted abstract
Background: The aim of the present study was to evaluate the predictors of transfer to home hemodialysis (HHD) after peritoneal dialysis (PD) completion.

Methods: All Australian and New Zealand patients treated with PD on day 90 after initiation of renal replacement therapy between 2000 and 2012 were included. Completion of PD was defined by death, transplantation, or hemodialysis (HD) for 180 days or more. Patients were categorized as “transferred to HHD” if they initiated HHD fewer than 180 days after PD had ended. Multivariable logistic regression was used to evaluate predictors of transfer to HHD in a restricted cohort experiencing PD technique failure; a competing-risks analysis was used in the unrestricted cohort.

Results: Of 10 710 incident PD patients, 3752 died, 1549 underwent transplantation, and 2915 transferred to HD, among whom 156 (5.4%) started HHD. The positive predictors of transfer to HHD in the restricted cohort were male sex [odds ratio (OR): 2.81], obesity (OR: 2.20), and PD therapy duration (OR: 1.10 per year). Negative predictors included age (OR: 0.95 per year), infectious cause of technique failure (OR: 0.48), underweight (OR: 0.50), kidney disease resulting from hypertension (OR: 0.38) or diabetes (OR: 0.32), race being Maori (OR: 0.65) or Aboriginal and Torres Strait Islander (OR: 0.30). Comparable results were obtained with a competing-risks model.

Conclusions: Transfer to HHD after completion of PD is rare and predicted by patient characteristics at baseline and at the time of PD end. Transition to HHD should be considered more often in patients using PD, especially when they fulfill the identified characteristics.
Keyword ANZDATA
Dialysis transition
Home hemodialysis
Technique failure
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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