Multicentre registry analysis of incremental peritoneal dialysis incidence and associations with patient outcomes

Author:

Cheetham Melissa S12,Cho Yeoungjee2345,Krishnasamy Rathika123,Milanzi Elasma3,Chow Josephine6789,Hawley Carmel2345,Moodie Jo-Anne10,Jose Matthew D111213,MacGinley Robert14,Nguyen Thu15,Palmer Suetonia C16,Walker Rachael17,Wong Jeffrey18,Jain Arsh K19,Boudville Neil2021,Johnson David W2345,Huang Louis L14

Affiliation:

1. Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Australia

2. Faculty of Medicine, The University of Queensland, Brisbane, Australia

3. Australasian Kidney Trials Network at the University of Queensland, Brisbane, Australia

4. Translational Research Institute, Brisbane, Australia

5. Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia

6. Clinical Innovation and Business Unit, South Western Sydney Local Health District, Australia

7. Faculty of Medicine, University of New South Wales, Sydney, Australia

8. Nursing and Midwifery Research Alliance, The Ingham Institute for Applied Medical Research, Australia

9. NICM Health Research Institute, Western Sydney University, Australia

10. Department of Nephrology, Royal Melbourne Hospital, Australia

11. Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), Australia

12. Renal Unit, Royal Hobart Hospital, Tasmania, Australia

13. School of Medicine, University of Tasmania, Australia

14. Department of Renal Medicine, Eastern Health Clinical School, Monash University, Melbourne, Australia

15. Department of Renal Medicine, Auckland District Health Board, New Zealand

16. Department of Medicine, University of Otago, Christchurch, New Zealand

17. School of Nursing, Eastern Institute of Technology, Hawke’s Bay, New Zealand

18. Department of Nephrology, Liverpool Hospital, South Western Sydney Local Health District, Australia

19. Schulich School of Medicine and Dentistry, Department of Epidemiology and Biostatistics, Western University, London, Canada

20. Medical School, University of Western Australia, Perth, Australia

21. Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia

Abstract

Background: Incremental peritoneal dialysis (PD) is increasingly advocated to reduce treatment burden and costs, with potential to better preserve residual kidney function. Global prevalence of incremental PD use is unknown and use in Australia and New Zealand has not been reported. Methods: Binational registry analysis including incident adult PD patients in Australia and New Zealand (2007–2017), examining incidence of and outcomes associated with incremental PD (first recorded PD exchange volume <42 L/week (incremental) vs. ≥42 L/week (standard)). Results: Incremental PD use significantly increased from 2.7% of all incident PD in 2007 to 11.1% in 2017 (mean increase 0.84%/year). Duration of incremental PD use was 1 year or less in 67% of cases. Male sex, Aboriginal and Torres Strait Islander (ATSI) or Māori ethnicities, age 45–59 years, medical comorbidities or treatment at a centre with low use of automated PD or icodextrin was associated with lower incidence of incremental PD use. Low body mass index and higher estimated glomerular filtration rate was associated with higher incidence. After accounting for patient and centre variables, commencing PD with an incremental prescription was associated with reduced peritonitis risk (adjusted hazard ratio 0.73, 95% confidence interval (CI) 0.61–0.86).When kidney transplantation and death were considered as competing risks, the association between incremental PD and peritonitis was not significant (sub-hazard ratio [SHR] 0.91, 95%CI 0.71–1.17, p = 0.5), however cumulative incidence of 30-day transfer to haemodialysis was lower in those receiving incremental PD (SHR 0.73, 95%CI 0.56–0.94, p = 0.01). There was no association between incremental PD and death. Conclusions: Incremental PD use is increasing in Australia and New Zealand and is not associated with patient harm.

Publisher

SAGE Publications

Subject

Nephrology,General Medicine

Cited by 3 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Global structures, practices, and tools for provision of chronic peritoneal dialysis;Nephrology Dialysis Transplantation;2024-09

2. Effects of incremental peritoneal dialysis with low glucose-degradation product neutral pH solution on clinical outcomes;International Urology and Nephrology;2024-05-14

3. Incremental peritoneal dialysis: Incremental gains;Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis;2023-09

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