Fp468risk Predictors and Causes of Technique Failure Within the First Year of Peritoneal Dialysis
Year: 2018
Type: conference-abstract
Abstract: INTRODUCTION AND AIMS: Technique failure is a major complication of peritoneal dialysis (PD) treatment and is associated with significant risk to patients and health services. The first year has been recognised as a particularly vulnerable period, with studies estimating that just under one-half of patients who develop technique failure do so within this time. This study aimed to identify the key risk factors and risk periods for early transfer to haemodialysis or death in incident PD patients. METHODS: Using data from the ANZDATA Registry, this study included all adult patients who commenced PD in Australia and New Zealand between 2000 and 2014. Competing risk regression models were used to analyse the primary outcome, which was technique failure within the first year (kidney transplantation was the competing risk), as well as the secondary outcomes, which examined each cause of technique failure (kidney transplantation and other causes of technique failure were the competing risks). Patients were censored at the time of kidney transplantation, recovery of renal function, loss to follow up, or at 365.25 days after commencement of PD. RESULTS: Of 16,748 patients who commenced PD during the study period, 4,389 patients reached the primary outcome. Factors associated with increased risk included age >70 years, diabetes or vascular disease, prior renal replacement therapy, late referral to a nephrology service, or management in a smaller centre. Asian or other race and use of continuous ambulatory PD were associated with reduced risk, as was commencement of PD between 2010 and 2014. Although the risk of technique failure due to death or infection was constant over the first year, mechanical and other causes accounted for a greater number of cases within the initial 9 months of treatment. CONCLUSIONS: Several modifiable and non-modifiable factors are associated with early technique failure. Variation in the principal cause of early technique failure implies that traditional approaches focusing solely on the reduction of peritonitis may not improve early technique failure rates. Rather, targeted interventions, including individualised training practices, implementation of community-based support programs, and consolidation of surgical expertise, should be considered in high risk patients to avoid the consequences of an unplanned transfer to haemodialysis or death.
Language: English
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2804888722