#6918 PATIENT AND TECHNIQUE SURVIVAL ON PERITONEAL DIALYSIS: A RETROSPECTIVE STUDY
Authors: Scarmignan Roberta , Alfano Gaetano , Fontana Francesco , Magistroni Riccardo , Donati Gabriele 
Published: June 2023

Abstract

Background and Aims
Peritoneal dialysis (PD) is a well-established replacement therapy for patients with end-stage kidney disease (ESKD). Despite innovations in PD fluid composition, PD patients experience a high morbidity rate. In particular, patients on PD have a high likelihood to switch from PD to HD due to catheter malfunction, peritonitis and ultrafiltration failure. A considerable number of risk factors are associated with a high risk of death, almost comparable with patients receiving hemodialysis (HD). This study aimed to analyze the outcome of patients receiving PD.

Method
A single center-retrospective study was conducted at the University Hospital of Modena. We collected data from patients who started PD from 1996 to 2021. Data were extracted from electronic healthcare records. Subjects aged &lt; 18 years were excluded. Patients with pre-existing abdominal wall defects (i.e., hernia), low-back pain, obesity and active working life were treated by automated peritoneal dialysis (APD). Kt/V was performed at least 3 times per year. Low depurative efficacy, ultrafiltration failure and severe abdominal pathology were causes of permanent transition from HD to PD. Baseline characteristics were described using mean and standard deviation (SD), or frequencies. The chi-square or Fisher's test, and student's t-test were used to compare categorical and continuous variables between groups. For survival analysis were used Kaplan-Meier and Cox regression methods. A P value of &lt;0.05 was considered statistically significant. All statistical analyses were performed using SPSS® statistical software.

Results
During the observational period, 497 patients on PD were enrolled in the study. Mean age was 63.5 (±15.6) years. Most of them were male (61%). Overall, 62.1% of the patients had at least 3 comorbidities beyond ESKD. Patients were affected by hypertension (70.4%), dyslipidemia (56.9%), cardiovascular disease (53.5%), hyperuricemia (41.6%) and diabetes (15.7%). Only 20.3% of the patients were on therapy with renin-angiotensin system inhibitors. PD was commenced at eGFR of 7±2.1 ml/min and CAPD (65.1%) was the modality of choice at the start of PD. The mean follow-up was 2.9 (±2.4) years. At end of the follow-up, 204 (41%) switched from PD to HD, 137 (27%) died, 92 (18.5%) underwent kidney transplantation and 64 (12.9%) were alive. On average, the switch from PD to home HD occurred after 3.3±2.7 years. The likelihood of transition from PD to HD for this group of patients was 10.7%, 30.3% 52.3%, and 70.3% at 1-,3-,5-, and 7 years, respectively (Fig. 1A). Patients who switched to HD were more frequently affected by diabetes (p = 0.02), hyperuricemia (p = &lt;0.001) and hypercholesterolemia (p = 0.001) than those who remained in DP. Overall, males anticipated of 1.1 years the transition to HD compared to the females (p = 0.006). All-cause mortality in DP patients was 100.3 per 1000 person-years. In patients aged &gt;75 years, mortality accounted for 242.1 per 1000 person-years. Cumulative all-cause 1-, 3-,5-, and 7-year mortality accounted for 8.8%, 26%, 40.4% and 55.1%, respectively (Fig. 1B). Multivariate Cox regression analysis showed that age was the only risk factor for mortality in our cohort of patients (HR = 1.07 [95%CI 1.05-1.08]; p = &lt;0.001) whereas no risk factors for the transition to HD were found in our cohort of patients.

Conclusion
In our study PD patients had a high burden of comorbidities and were frequently subject to the transition to HD. Age was an independent predictor of mortality in this dynamic population. No risk factors for the transition from PD to HD were identified in this group of patients.