Work

Evolving Comorbidity Burden and Clinical Characteristics in Peritoneal Dialysis: A 17-Year Nationwide Study

Year: 2026

Type: article

Abstract: Rationale & Objective Peritoneal dialysis (PD) is a home-based kidney replacement therapy for patients with kidney failure associated with numerous benefits, but it remains underused. As chronic kidney disease becomes a growing public health concern, understanding the evolving clinical profile of PD patients is essential. There is limited information available on the temporal trends in patients' comorbidities within this population. The study aimed to describe changes in the prevalence of comorbidities among PD patients. Study Design We conducted a retrospective multicenter study. Setting & Participants We used data from the French Peritoneal Dialysis Registry, including 15,982 patients who initiated PD in France between 2002, and 2018. Exposure(s) or predictor(s) Calendar year of PD initiation. Outcome(s) Prevalence of high comorbidity burden, clinical profile, and care delivery characteristics at PD initiation. Analytical Approach We aimed to assess temporal trends in outcomes of interest among incident PD patients using Cox regression models with robust variance estimation, adjusting for confounders identified through directed acyclic graphs, and accounting for potential nonlinear effects of PD start year. Results The proportion of patients over 85 years increased over time (Prevalence Ratio (PR) 1.44, 95% CI: 1.25–1.67), as did diabetes prevalence (PR 1.16, 95% CI: 1.08–1.25). Conversely, the proportion of patients with CCI ≥2 declined (PR 0.89, 95% CI: 0.85–0.94), as did those requiring assistance (PR 0.90, 95% CI: 0.85–0.95) and those considered ineligible for a kidney transplantation (PR 0.63, 95% CI: 0.60–0.66). Limitations The retrospective design limited causal inference and the CCI may not capture all health dimensions relevant to PD patients. Conclusions The proportion of diabetes and older patients increased over time, whereas the Charlson Comorbidity Index, the proportion of patients uneligible for a kidney transplantation and the requirement of assistance decreased, reflecting an evolving profile of PD patients. PLAIN-LANGUAGE SUMMARY Peritoneal dialysis is a home-based treatment for people with kidney failure, but it remains underused. The characteristics of patients starting this treatment may have changed over time. Using data from a national French registry, we examined how the health profiles of patients beginning peritoneal dialysis have evolved. We found that patients starting peritoneal dialysis are increasingly older and more likely to have diabetes. At the same time, fewer patients have a high overall burden of other medical conditions, need assistance with dialysis, or are considered ineligible for kidney transplantation. These results show that the profile of patients starting peritoneal dialysis has changed, which may help clinicians in routine clinical practice.

Source: Kidney Medicine

DOI: 10.1016/j.xkme.2026.101392

Authors: Anne-Sophie Lavedrine, Annabel Boyer, Thierry Lobbedez, Clémence Béchade, Antoine Lanot

Institutions: Inserm, Normandie Université, Centre Hospitalier Universitaire de Caen Normandie, Unité de recherche interdisciplinaire pour la prévention et le traitement des cancers, Université de Caen Normandie

Language: English

Topic: Dialysis and Renal Disease Management

Subfield: Nephrology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,590